Methods for the diagnosis of fetal disease

ABSTRACT

Methods are provided for detecting an aneuploidy in a fetus. These methods can be used to detect trisomy 13, 8 or 21, amongst other aneupoloidies. In some embodiments, the methods include selectively purifying fetal DNA from a maternal biological sample using the methylation status of a CpG containing genomic sequence and genotyping the fetus using the purified fetal DNA, thereby detecting aneuploidy in the fetus.

CROSS REFERENCE TO RELATED APPLICATIONS

This claims the benefit of U.S. Provisional Application No. 61/361,824, filed Jul. 6, 2010, which is incorporated by reference herein in its entirety.

FIELD

This related to the field of prenatal diagnosis, specifically to the diagnosis of fetal aneuploidy, such as an aneuploidy of chromosome 13, 18, 21, X or Y.

BACKGROUND

Definitive prenatal diagnosis of fetal aneuploidy is currently performed using chorionic villus sampling (CVS) or amniocentesis. These are invasive, expensive and somewhat risky approaches that must be performed by experienced clinicians and are generally only offered to expectant mothers considered to be at elevated risk of carrying a genetically abnormal fetus. Low cost minimally invasive screening is routinely used across the maternal age range but this is based upon the quantification of serum proteins that are surrogate markers of the underlying genetic abnormality and do not achieve desirable levels of sensitivity and specificity (Wapner et al., N. Eng J. Med. 349: 1405-13, 2003; Alfirevic and Neilson, BMJ 326: 811-2, 2004; Malone et al., N Engl. J. Med 353: 2001-11, 2005).

An attractive alternative involves the analysis of placentally-derived nucleic acids in maternal plasma to characterize specific features of the fetal genome (Lo, Ann. NY. Acad. Sci. 1137: 140-3, 2008). However, because of the technical challenge of distinguishing maternally inherited fetal alleles from endogenous maternal DNA this approach has largely been limited to the detection of paternally inherited disease-causing mutations (Zimmermann et al., Methods Mol Med 132: 43-49, 2007; Li et al., Prenat Diag 27: 11-7, 2007). Differential DNA methylation patterns between the placental and maternal leukocyte genomes at distinct loci have been used to determine the fetal genotype (Lo et al., PNAS 104: 13116-21, 2007; Lo et al., Nat Med 13:218-23, 2007). Specific polymerase chain reaction (PCR)-based assays were used that amplify a given methylated (placental), but not an unmethylated (maternal) locus (or visa versa) in DNA obtained from maternal plasma (Tsui et al., Prenat Diag 27: 1212-8, 2007; Tong et al., Clin Chem 53: 1906-14, 2007; Chan et al., Clin Chem 52: 2211-8, 2006; Tong et al., Clin Chem 52: 2194-202, 2006). However, a need remains for sensitive and specific non-invasive methods that can be used to diagnose fetal conditions, such as aneuploidy, using the placental methylome.

SUMMARY

Methods are provided for detecting a chromosome abnormality such as an aneuploidy in a fetus. These methods can be used to detect trisomy 13, 8, 21, X and/or Y, amongst other aneupoloidies. In some embodiments, the methods detect a trisomy of chromosome 13, 8, and/or 21. In other embodiments the methods detect Turner's Syndrome (XO).

In some embodiments, the methods include selectively purifying fetal DNA from a maternal biological sample using the methylation status of a CpG containing genomic sequence. The allele frequency is then determined in the purified fetal DNA, thereby detecting aneuploidy in the fetus.

In some embodiments, methods are provided for detecting an aneuploidy in a fetus. The methods include (a) selectively purifying fetal DNA from a maternal biological sample using the methylation status of a CpG containing genomic sequence, wherein the CpG-containing genomic sequence is at least 15 nucleotides in length, comprises at least one CpG dinucleotide, and is within a region on chromosome 13, 18 or 21, and wherein the CpG-containing genomic sequence comprises at least 15 nucleotides of at least one of the nucleic acid sequences set forth as any one of SEQ ID NOs: 1-68 or 83-85; and (b) genotyping the fetus using the purified fetal DNA, thereby detecting aneuploidy in the fetus.

In some, but not all, embodiments, the fetus is genotyped using a genetic marker, such as a single nucleotide polymorphism (SNP) that is genetically linked to any one of SEQ ID NOs: 1-68 or 83-85. In some examples, the SNP is within about 150 base pairs of at least one of SEQ ID NOs: 1-68 or 83-85. Other genetic markers are also of use, such as a short tandem repeat (STR).

In some embodiments, the allelic ratio is determined. In some examples, an allelic ratio of 1:2 or 2:1 indicates that the fetus is aneuploid. In other examples, an allelic ratio of 0:1 or 1:0 indicates that the fetus is aneuploidy.

The foregoing and other features and advantages will become more apparent from the following detailed description of several embodiments, which proceeds with reference to the accompanying figures.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a schematic diagram of the reaction scheme used to prepare libraries of genomic DNA fragments that are depleted for hypomethylated CpG sites in either CVS or MBC tissues.

FIG. 2A-B is a set of graphs. FIG. 2A is a summary of pyrosequencing analysis for four CpG sites across chromosomes 13, 18 and 21. Sample n=10 CVS and 10 MBC. FIG. 2 b is a summary of Mass Array/Epityper analysis for CpG sites across chromosomes 13, 18 and 21. Sample n=23 CVS and 23 MBC. For both data sets, fully methylated control samples were obtained from Millipore (part number S7821). The Y axis is methylation rate, i.e., the proportion of CpG sites that are methylated. The whiskers above each bar are the upper boundaries of the confidence intervals of the estimated methylation rates.

FIG. 3 is a presentation of data from a real time PCR analysis of two different maternal plasma samples. Each cluster of four dots represents 4 replicates for each condition. The cluster represented by the * is from maternal plasma DNA that was not cut with HpaII. Therefore there is no selection for fetal DNA and the overwhelming signal read by the instrument is the TT genotype. When this DNA is cut with HpaII the fetal DNA is preserved and the maternal DNA lost because it will not amplify (@). The bottom two clusters are from a second plasma sample. The lowest cluster is the uncut (sham) sample and clearly shows the maternal CC genotype (#). The higher of the two is the fetal genotype (CT) that has is detectable only after selection of fetal DNA via HpaII digestion ($). The nucleic acid sequence reference is SEQ ID NO: 1.

SEQUENCE LISTING

The nucleic and amino acid sequences listed in the accompanying sequence listing are shown using standard letter abbreviations for nucleotide bases, and three letter code for amino acids, as defined in 37 C.F.R. 1.822. Only one strand of each nucleic acid sequence is shown, but the complementary strand is understood as included by any reference to the displayed strand. The Sequence Listing is submitted as an ASCII text file [8123-83157-03sequence.txt, 64 kB, Jul. 5, 2011], and incorporated by reference herein. In the accompanying sequence listing:

SEQ ID NOs: 1-68 and 83 are nucleic acid sequences of regions of human chromosomal DNA that are methylated in a fetal genome as compared to a maternal genome.

SEQ ID NOs: 69-82 are primer sequences.

DETAILED DESCRIPTION

Methods are provided herein for detecting an aneuploidy in a fetus. These methods include selectively purifying fetal DNA from a maternal biological sample using the methylation status of a CpG containing genomic sequence. The copy number of a DNA sequence included in the fetal genome is then determined.

In some embodiments, the CpG-containing genomic sequence is at least 15 nucleotides in length. In some embodiments, the CpG containing sequence comprises at least one CpG dinucleotide, and is within a region on chromosome 13, 18, 21, X or Y. In specific examples, the CpG-containing genomic sequence comprises at least 15 nucleotides of at least one of the nucleic acid sequences set forth as SEQ ID NOs: 1-68 or 83-85. In other specific non-limiting examples, the methylation status of the entirety of one or more of SEQ ID NO:s: 1-68 or 83-85 can also be determined.

These methods can include genotyping the fetus using the purified fetal DNA, thereby detecting aneuploidy of chromosome 13, 18 or 21 in the fetus. However, these methods can be applied to other chromosomes, including the X chromosome.

Terms

Unless otherwise noted, technical terms are used according to conventional usage. Definitions of common terms in molecular biology may be found in Benjamin Lewin, Genes V, published by Oxford University Press, 1994 (ISBN 0-19-854287-9); Kendrew et al. (eds.), The Encyclopedia of Molecular Biology, published by Blackwell Science Ltd., 1994 (ISBN 0-632-02182-9); and Robert A. Meyers (ed.), Molecular Biology and Biotechnology: a Comprehensive Desk Reference, published by VCH Publishers, Inc., 1995 (ISBN 1-56081-569-8).

In order to facilitate review of the various embodiments of this disclosure, the following explanations of specific terms are provided:

Allelic ratio: An allele is one DNA sequence of a given genetic locus. The number of each alleles in an individual is an allelic ratio. Generally, an allelic ratio of 2:0 or 0:2 is a homozygote, and an allelic ratio of 1:1 is a heterozygote at the locus. An allelic ratio of 1:2 or 2:1 indicates that a subject, such as a fetus, is aneuploid. An allelic ratio of 1:0 or 0:1, such as for the X chromosome ratio in a subject that is phenotypically female, can also indicate that the subject is aneuploid.

Amplification: To increase the number of copies of a nucleic acid molecule. The resulting amplification products are called “amplicons.” Amplification of a nucleic acid molecule (such as a DNA or RNA molecule) refers to use of a technique that increases the number of copies of a nucleic acid molecule in a sample. An example of amplification is the polymerase chain reaction (PCR), in which a sample is contacted with a pair of oligonucleotide primers under conditions that allow for the hybridization of the primers to a nucleic acid template in the sample. The primers are extended under suitable conditions, dissociated from the template, re-annealed, extended, and dissociated to amplify the number of copies of the nucleic acid. This cycle can be repeated. The product of amplification can be characterized by such techniques as electrophoresis, restriction endonuclease cleavage patterns, oligonucleotide hybridization or ligation, and/or nucleic acid sequencing.

Other examples of in vitro amplification techniques include quantitative real-time PCR; reverse transcriptase PCR (RT-PCR); real-time PCR (rt PCR); real-time reverse transcriptase PCR (rt RT-PCR); nested PCR; strand displacement amplification (see U.S. Pat. No. 5,744,311); transcription-free isothermal amplification (see U.S. Pat. No. 6,033,881); repair chain reaction amplification (see PCT Publication No. WO 90/01069); ligase chain reaction amplification (see European patent publication No. EP-A-320 308); gap filling ligase chain reaction amplification (see U.S. Pat. No. 5,427,930); coupled ligase detection and PCR (see U.S. Pat. No. 6,027,889); and NASBA™ RNA transcription-free amplification (see U.S. Pat. No. 6,025,134), amongst others.

Allele (Haplotype): A 5′ to 3′ sequence of nucleotides found at a set of one or more polymorphic sites in a locus on a single chromosome from a single individual. “Allelic pair” is the two alleles found for a locus in a single individual. With regard to a population, alleles are the ordered, linear combination of polymorphisms (e.g., single nucleotide polymorphisms (SNPs) in the sequence of each faun of a gene (on individual chromosomes) that exist in the population. “Haplotyping” is a process for determining one or more alleles in an individual and includes use of family pedigrees, molecular techniques and/or statistical inference. “Haplotype data” or “allele data” is the information concerning one or more of the following for a specific gene: a listing of the allelic pairs in an individual or in each individual in a population; a listing of the different alleles in a population; frequency of each allele in that or other populations, and any known associations between one or more alleles and a trait.

Aneuploidy: An abnormal number of chromosomes. Monosomy refers to the presence of only one chromosome, wherein two copies is normal. Monosomy of the X chromosome (45,X) causes Turner's syndrome. Trisomy refers to the presence of three copies (instead of the normal two) of specific chromosomes. Trisomy 21 causes Down's syndrome. Tripsome 10 and Trisomy 31, known as Edwards and Patau Syndrome, respectively, are two autosomal abnormalities. Trisomy X has also been observed in humans (47, XXX).

Germline aneuploidy can be detected through karyotyping, a process in which a sample of cells is fixed and stained to create the typical light and dark chromosomal banding pattern and a picture of the chromosomes is analyzed. Other techniques include Fluorescence In Situ Hybridization (FISH), Quantitative Polymerase Chain Reaction (PCR) of Short Tandem Repeats, Quantitative Fluorescence PCR (QF-PCR), Quantitative Real-time PCR(RT-PCR) dosage analysis, Quantitative Mass Spectrometry of Single Nucleotide Polymorphisms, and Comparative Genomic Hybridization (CGH).

Array: An arrangement of molecules, such as biological macromolecules (such as polypeptides or nucleic acids) or biological samples (such as tissue sections), in addressable locations on or in a substrate. A “microarray” is an array that is miniaturized so as to require or be aided by microscopic examination for evaluation or analysis. Arrays are sometimes called DNA chips or biochips.

The array of molecules (“features”) makes it possible to carry out a very large number of analyses on a sample at one time. In certain example arrays, one or more molecules (such as an oligonucleotide probe) will occur on the array a plurality of times (such as twice), for instance to provide internal controls. The number of addressable locations on the array can vary, for example from a few (such as three) to at least six, at least 20, at least 25, or more. In particular examples, an array includes nucleic acid molecules, such as oligonucleotide sequences that are at least 15 nucleotides in length, such as about 15-40 nucleotides in length, such as at least 18 nucleotides in length, at least 21 nucleotides in length, or even at least 25 nucleotides in length. In one example, the molecule includes oligonucleotides attached to the array via their 5′- or 3′-end.

Within an array, each arrayed sample is addressable, in that its location can be reliably and consistently determined within at least two dimensions of the array. The feature application location on an array can assume different shapes. For example, the array can be regular (such as arranged in uniform rows and columns) or irregular. Thus, in ordered arrays the location of each sample is assigned to the sample at the time when it is applied to the array, and a key may be provided in order to correlate each location with the appropriate target or feature position. Often, ordered arrays are arranged in a symmetrical grid pattern, but samples could be arranged in other patterns (such as in radially distributed lines, spiral lines, or ordered clusters). Addressable arrays usually are computer readable, in that a computer can be programmed to correlate a particular address on the array with information about the sample at that position (such as hybridization or binding data, including for instance signal intensity). In some examples of computer readable formats, the individual features in the array are arranged regularly, for instance in a Cartesian grid pattern, which can be correlated to address information by a computer.

Bi-Allelic Single Nucleotide Polymorphism: A polymorphism (one nucleotide) that differs between the two alleles in an individual. Thus, the individual is heterozygous at this genetic loci.

Bisulfite: All types of bisulfites, such as sodium bisulfate, that are capable of chemically converting a cytosine (C) to a uracil (U) without chemically modifying a methylated cytosine and therefore can be used to differentially modify a DNA sequence based on the methylation status of the DNA.

Chromosomal abnormality: A chromosome with DNA deletions or duplications and chromosomal aneuploidy. The term also encompasses translocation of extra chromosomal sequences to other chromosomes.

Chromosomal aneuploidy or aneuploidy: The abnormal presence (hyperploidy) or absence (hypoploidy) of a chromosome, such as chromosome 13, 18 or 21. In some cases, the abnormality can involve more than one chromosome, or more than one portion of one or more chromosomes. The most common chromosome aneuploidy is trisomy, such as trisomy 21, where the genome of an afflicted patient has three chromosomes 21, as compared to two chromosomes 21. In rarer cases, the patient may have an extra piece of chromosome 21 (less than full length) in addition to the normal pair. In yet other cases, a portion of chromosome 21 may be translocated to another chromosome, such as chromosome 14. In this example, chromosome 21 is referred as the “chromosome relevant to the chromosomal aneuploidy” and a second, chromosome that is present in the normal pair in the patient's genome, for example chromosome 1, is a “reference chromosome.” There are also cases where the number of a relevant chromosome is less than the normal number of 2. Turner syndrome is one example of a chromosomal aneuploidy where the number of X chromosome in a female subject has been reduced from two to one.

CpG-containing genomic sequence: A segment of DNA sequence at a defined location in the genome of an individual such as a human fetus or a pregnant woman. Typically, a “CpG-containing genomic sequence” is at least 15 nucleotides in length and contains at least one cytosine. In some embodiments, a CpG containing sequence can be at least 30, 50, 80, 100, 150, 200, 250, or 300 nucleotides in length and contains at least 2, 5, 10, 15, 20, 25, or 30 cytosines. For any specific “CpG-containing genomic sequence” at a given location, for example, within a region centering around a given genetic locus on chromosome 21 nucleotide sequence variations can exist from individual to individual and from allele to allele even for the same individual. Typically, such a region centering around a defined genetic locus (e.g., a CpG island) contains the locus as well as upstream and/or downstream sequences. Each of the upstream or downstream sequence (counting from the 5′ or 3′ boundary of the genetic locus, respectively) can be as long as 1 kb, in other cases may be as long as 5 kb, 2 kb, 750 bp, 500 bp, 200 bp, or 100 bp. A “CpG-containing genomic sequence” can encompass a coding or a non-coding, nucleic acid sequence, and thus can include a nucleotide sequence transcribed (or not transcribed) for protein production. Thus, a CpG containing genomic sequence can be a nucleotide sequence can be a protein-coding sequence, a non protein-coding sequence or a combination thereof.

CpG island: A segment of DNA sequence in which the frequency of CpG dinucleotide sequences is higher than other dinucleotide sequences. Generally, a CpG island is found in a genome that has a minimal length, a minimal GC content, and a minimal ratio of observed CpG frequency/expected CpG frequency (OCF/ECF).

In one embodiment, a CpG island has (1) at least 200 nucleotides in length, (2) has a greater than 50% GC content, and (3) an OCF/ECF ratio greater than 0.6 (see Takai et al., Proc. Natl. Acad. Sci. U.S.A. 99:3740-3745, 2002). In another embodiment, a CpG island has (1) at least 400 nucleotides in length; (2) a greater than 50% GC content; and (3) an OCF/ECF ratio greater than 0.6 (see Yamada et al. (Genome Research 14:247-266, 2004). A “CpG island” on chromosome 13, 18 or 21 can fits the CpG island profiles provided by any one of the currently available computational programs designed for scanning chromosomes based on the above stated criteria, encompassing results obtained when using window sizes of 100, 200, or 300 nucleotides and shift or step sizes of 1, 2, or 3 nucleotides in the screening process. The individual CpG islands named in this disclosure are further defined by including the sequence, but can also be identified by contig number, version and region at GENBANK®, chromosomal location relative to the chromosome 13, 18 or 21 sequence, respectively, of the Human May 2004 (hg17) assembly of the UCSC Genome Browser (See the UCSC website).

Control DNA: Genomic DNA obtained from an individual that is used for comparative purposes, such as DNA from a healthy individual who does not have a chromosomal abnormality. In some embodiments, a control DNA sample can be obtained from plasma of a female carrying a healthy fetus who does not have a chromosomal abnormality, which can serve as a negative control. When certain chromosome anomalies are known, the control can also be established standards that are indicative of a specific disease or condition.

To screen for three different chromosomal aneuploidies in a maternal plasma of a pregnant female, a panel of control DNAs that have been isolated from plasma of mothers who are known to carry a fetus with, for example, chromosome 13, 18, or 21 trisomy, and a mother who is pregnant with a fetus who does not have a chromosomal abnormality can be used as a positive control.

Copy number: The number of copies of a section of DNA in a genome. Copy number analysis usually refers to the process of analyzing data produced by a test for DNA copy number variation in patient's sample. Such analysis helps detect chromosomal copy number variation that may cause or may increase risks of various critical disorders. Copy number variation can be detected with various types of tests, including, but not limited to, such as methylation status, fluorescent in situ hybridization, comparative genomic hybridization high-resolution array-based tests based on array comparative genomic and SNP array technologies. The methods disclosed herein can be used to determine the copy number of a specific locus of interest.

DNA (deoxyribonucleic acid): DNA is a long chain polymer which comprises the genetic material of most living organisms (some viruses have genes comprising ribonucleic acid (RNA)). The repeating units in DNA polymers are four different nucleotides, each of which comprises one of the four bases, adenine, guanine, cytosine and thymine bound to a deoxyribose sugar to which a phosphate group is attached. Triplets of nucleotides (referred to as codons) code for each amino acid in a polypeptide, or for a stop signal (termination codon). The term codon is also used for the corresponding (and complementary) sequences of three nucleotides in the mRNA into which the DNA sequence is transcribed.

Unless otherwise specified, any reference to a DNA molecule is intended to include the reverse complement of that DNA molecule. Except where single-strandedness is required by the text herein, DNA molecules, though written to depict only a single strand, encompass both strands of a double-stranded DNA molecule. Thus, a reference to the nucleic acid molecule that encodes a protein, or a fragment thereof, encompasses both the sense strand and its reverse complement. Thus, for instance, it is appropriate to generate probes or primers from the reverse complement sequence of the disclosed nucleic acid molecules.

Differentially Modifies (methylated or non-methylated DNA): A reagent that modifies methylated or non-methylated DNA, respectively, in a process through which distinguishable products result from methylated and non-methylated DNA, thereby allowing the identification of the DNA methylation status. Such processes may include, but are not limited to, chemical reactions (such as conversion by bisulfate) and enzymatic treatment (such as cleavage by a methylation-dependent endonuclease), or an antibody that specifically binds a methylated (or non-methylated) DNA sequence. Thus, an enzyme that preferentially cleaves or digests methylated DNA is one capable of cleaving or digesting a DNA molecule at a significantly higher efficiency when the DNA is methylated, whereas an enzyme that preferentially cleaves or digests unmethylated DNA exhibits a significantly higher efficiency when the DNA is not methylated.

Epigenetic status: Any structural feature at the molecular level of a nucleic acid (e.g., DNA or RNA) other than the primary nucleotide sequence. For instance, the epigenetic state of a genomic DNA may include its secondary or tertiary structure determined or influenced by, for example, its methylation pattern or its association with cellular proteins, such as histones, and the modifications of such proteins, such as acetylation, deacetylation, and methylation.

Gene: A segment of DNA that contains the coding sequence for a protein, wherein the segment may include promoters, exons, introns, and other untranslated regions that control expression.

Genotype: An unphased 5′ to 3′ sequence of nucleotide pair(s) found at a set of one or more polymorphic sites in a locus on a pair of homologous chromosomes in an individual. “Genotyping” is a process for determining a genotype of an individual.

Genomic target sequence: A sequence of nucleotides located in a particular region in the human genome that corresponds to one or more specific genetic abnormalities, such as a nucleotide polymorphism, a deletion, an insertion, or an amplification. The target can be for instance a coding sequence; it can also be the non-coding strand that corresponds to a coding sequence. The target can also be a non-coding sequence, such as an intronic sequence.

Heterozygous: An organism is heterozygous for a particular allele when two different alleles occupy the gene's position (locus) on the homologous chromosomes. The cell or organism is called a heterozygote.

Hybridization: Oligonucleotides and their analogs hybridize by hydrogen bonding, which includes Watson-Crick, Hoogsteen or reversed Hoogsteen hydrogen bonding, between complementary bases. Generally, nucleic acids consist of nitrogenous bases that are either pyrimidines (cytosine (C), uracil (U), and thymine (T)) or purines (adenine (A) and guanine (G)). These nitrogenous bases form hydrogen bonds between a pyrimidine and a purine, and the bonding of the pyrimidine to the purine is referred to as “base pairing.” More specifically, A will hydrogen bond to T or U, and G will bond to C. “Complementary” refers to the base pairing that occurs between two distinct nucleic acid sequences or two distinct regions of the same nucleic acid sequence. For example, an oligonucleotide can be complementary to a specific genetic locus, so it specifically hybridizes with a mutant allele (and not the reference allele) or so that it specifically hybridizes with a reference allele (and not the mutant allele).

“Specifically hybridizable” and “specifically complementary” are terms that indicate a sufficient degree of complementarity such that stable and specific binding occurs between the oligonucleotide (or its analog) and the DNA or RNA target, such that the target can be distinguished. The oligonucleotide or oligonucleotide analog need not be 100% complementary to its target sequence to be specifically hybridizable. An oligonucleotide or analog is specifically hybridizable when binding of the oligonucleotide or analog to the target DNA or RNA molecule interferes with the normal function of the target DNA or RNA, and there is a sufficient degree of complementarity to avoid non-specific binding of the oligonucleotide or analog to non-target sequences under conditions where specific binding is desired, for example under physiological conditions in the case of in vivo assays or systems. Such binding is referred to as specific hybridization. In one example, an oligonucleotide is specifically hybridizable to DNA or RNA nucleic acid sequences including an allele of a gene, wherein it will not hybridize to nucleic acid sequences containing a polymorphism.

Hybridization conditions resulting in particular degrees of stringency will vary depending upon the nature of the hybridization method of choice and the composition and length of the hybridizing nucleic acid sequences. Generally, the temperature of hybridization and the ionic strength (especially the Na⁺ concentration) of the hybridization buffer will determine the stringency of hybridization, though wash times Also influence stringency. Calculations regarding hybridization conditions required for attaining particular degrees of stringency are discussed by Sambrook et al. (ed.), Molecular Cloning: A Laboratory Manual, 2nd ed., vol. 1-3, Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y., 1989, chapters 9 and 11.

The following is an exemplary set of hybridization conditions and is not limiting:

Very High Stringency (Detects Sequences that Share at Least 90% Identity)

Hybridization: 5×SSC at 65° C. for 16 hours

Wash twice: 2×SSC at room temperature (RT) for 15 minutes each

Wash twice: 0.5×SSC at 65° C. for 20 minutes each

High Stringency (Detects Sequences that Share at Least 80% Identity)

Hybridization: 5×-6×SSC at 65° C.-70° C. for 16-20 hours

Wash twice: 2×SSC at RT for 5-20 minutes each

Wash twice: 1×SSC at 55° C.-70° C. for 30 minutes each

Low Stringency (Detects Sequences that Share at Least 50% Identity)

Hybridization: 6×SSC at RT to 55° C. for 16-20 hours

Wash at least twice: 2×-3×SSC at RT to 55° C. for 20-30 minutes each.

Increase or a Decrease: A significantly significant positive or negative change, respectively, in quantity from a control value. An increase is a positive change, such as a 50%, 100%, 200%, 300%, 400% or 500% increase as compared to the control value. A decrease is a negative change, such as a 50%, 100%, 200%, 300%, 400% or 500% decrease as compared to a control value.

Isolated: An “isolated” biological component (such as a nucleic acid molecule, protein or organelle) has been substantially separated or purified away from other biological components in the cell of the organism in which the component naturally occurs, i.e., other chromosomal and extra-chromosomal DNA and RNA, proteins and organelles. Nucleic acids and proteins that have been “isolated” include nucleic acids and proteins purified by standard purification methods. The term also embraces nucleic acids and proteins prepared by recombinant expression in a host cell as well as chemically synthesized nucleic acids.

Locus: A location on a chromosome or DNA molecule corresponding to a gene or a physical or phenotypic feature, where physical features include polymorphic sites.

Maternal allele frequency: The ratio, represented as a percent, of a maternal allele to the total amount of alleles present (both paternal and maternal). The term “paternal allele frequency” refers to the ratio, represented as a percent, of a paternal allele to the total amount of alleles present (both paternal and maternal).

Methylation status: The state of methylation of a genomic sequence. This refers to the characteristics of a DNA segment at a particular genomic locus relevant to methylation. Such characteristics include, but are not limited to, whether any of the cytosine (C) residues within this DNA sequence are methylated, location of methylated C residue(s), percentage of methylated C at any particular stretch of residues, and allelic differences in methylation. The methylation profile affects the relative or absolute concentration of methylated C or unmethylated C at any particular stretch of residues in a biological sample.

Methyl-sensitive enzymes: DNA restriction endonucleases that are dependent on the methylation state of their DNA recognition site for activity. For example, there are methyl-sensitive enzymes that cleave at their DNA recognition sequence only if it is not methylated. Thus, an unmethylated DNA sample will be cut into smaller fragments than a methylated DNA sample. Similarly, a hypermethylated DNA sample will not be cleaved. In contrast, there are methyl-sensitive enzymes that cleave at their DNA recognition sequence only if it is methylated. As used herein, the terms “cleave”, “cut” and “digest” are used interchangeably.

Methyl-sensitive enzymes that digest unmethylated DNA suitable for use in methods of the invention include, but are not limited to, HpaII, HhaI, MaeII, BstUI and AciI. One enzyme is HpaII that cuts only the unmethylated sequence CCGG. Enzymes that digest only methylated DNA include, but are not limited to, DpnI, which cuts at a recognition sequence GATC, and McrBC, which belongs to the family of AAA proteins (New England BioLabs, Inc., Beverly, Mass.).

Cleavage methods and procedures for selected restriction enzymes for cutting DNA at specific sites are well known to the skilled artisan. For example, many suppliers of restriction enzymes provide information on conditions and types of DNA sequences cut by specific restriction enzymes, including New England BioLabs, Promega Corporation, Boehringer-Mannheim, and the like. Sambrook et al. (See Sambrook et al., Molecular Biology: A Laboratory Approach, Cold Spring Harbor, N.Y. 1989) provide a general description of methods for using restriction enzymes and other enzymes.

Mutation: Any change of a nucleic acid sequence as a source of genetic variation. For example, mutations can occur within a gene or chromosome, including specific changes in non-coding regions of a chromosome, for instance changes in or near regulatory regions of genes. Types of mutations include, but are not limited to, base substitution point mutations (which are either transitions or transversions), deletions, and insertions. Missense mutations are those that introduce a different amino acid into the sequence of the encoded protein; nonsense mutations are those that introduce a new stop codon; and silent mutations are those that introduce the same amino acid often with a base change in the third position of the codon. In the case of insertions or deletions, mutations can be in-frame (not changing the frame of the overall sequence) or frame shift mutations, which may result in the misreading of a large number of codons (and often leads to abnormal termination of the encoded product due to the presence of a stop codon in the alternative frame).

Oligonucleotide: An oligonucleotide is a plurality of joined nucleotides joined by native phosphodiester bonds, between about 6 and about 300 nucleotides in length. An oligonucleotide analog refers to moieties that function similarly to oligonucleotides but have non-naturally occurring portions. For example, oligonucleotide analogs can contain non-naturally occurring portions, such as altered sugar moieties or inter-sugar linkages, such as a phosphorothioate oligodeoxynucleotide. Functional analogs of naturally occurring polynucleotides can bind to RNA or DNA, and include peptide nucleic acid (PNA) molecules.

In several examples, oligonucleotides and oligonucleotide analogs can include linear sequences up to about 200 nucleotides in length, for example a sequence (such as DNA or RNA) that is at least 6 bases, for example at least 8, 10, 15, 20, 25, 30, 35, 40, 45, 50, 100 or even 200 bases long, or from about 6 to about 70 bases, for example about 10-25 bases, such as 12, 15 or 20 bases.

Polymorphic marker: A segment of genomic DNA that exhibits heritable variation in a DNA sequence between individuals. Such markers include, but are not limited to, single nucleotide polymorphisms (SNPs), restriction fragment length polymorphisms (RFLPs), short tandem repeats, such as di-, tri- or tetra-nucleotide repeats (STRs), and the like. Polymorphic markers can be used to specifically differentiate between a maternal and paternal allele in the enriched fetal nucleic acid sample.

A “methyl-polymorphic marker” refers to a polymorphic marker that is adjacent to differentially methylated DNA regions of fetal and maternal DNA. The term adjacent refers to a marker that is within 1-3000 base pairs, preferably 1000 base pairs, such as 150 base pairs, 100 base pairs or 50 base pairs from a differentially methylated nucleotide.

Polymorphism: A variation in a gene sequence. The polymorphisms can be those variations (DNA sequence differences) which are generally found between individuals or different ethnic groups and geographic locations which, while having a different sequence, produce functionally equivalent gene products. Typically, the term can also refer to variants in the sequence which can lead to gene products that are not functionally equivalent. Polymorphisms also encompass variations which can be classified as alleles and/or mutations which can produce gene products which may have an altered function. Polymorphisms also encompass variations which can be classified as alleles and/or mutations which either produce no gene product or an inactive gene product or an active gene product produced at an abnormal rate or in an inappropriate tissue or in response to an inappropriate stimulus. Alleles are the alternate forms that occur at the polymorphism.

Polymorphisms can be referred to, for instance, by the nucleotide position at which the variation exists, by the change in amino acid sequence caused by the nucleotide variation, or by a change in some other characteristic of the nucleic acid molecule or protein that is linked to the variation.

Probes and primers: A probe comprises an isolated nucleic acid capable of hybridizing to a target nucleic acid. A detectable label or reporter molecule can be attached to a probe or primer. Typical labels include radioactive isotopes, enzyme substrates, co-factors, ligands, chemiluminescent or fluorescent agents, haptens, and enzymes. Methods for labeling and guidance in the choice of labels appropriate for various purposes are discussed, for example in Sambrook et al. (In Molecular Cloning: A Laboratory Manual, CSHL, New York, 1989) and Ausubel et al. (In Current Protocols in Molecular Biology, John Wiley & Sons, New York, 1998).

In a particular example, a probe includes at least one fluorophore, such as an acceptor fluorophore or donor fluorophore. For example, a fluorophore can be attached at the 5′- or 3′-end of the probe. In specific examples, the fluorophore is attached to the base at the 5′-end of the probe, the base at its 3′-end, the phosphate group at its 5′-end or a modified base, such as a T internal to the probe.

Probes are generally at least 15 nucleotides in length, such as at least 15, at least 16, at least 17, at least 18, at least 19, least 20, at least 21, at least 22, at least 23, at least 24, at least 25, at least 26, at least 27, at least 28, at least 29, at least 30, at least 31, at least 32, at least 33, at least 34, at least 35, at least 36, at least 37, at least 38, at least 39, at least 40, at least 41, at least 42, at least 43, at least 44, at least 45, at least 46, at least 47, at least 48, at least 49, at least 50 at least 51, at least 52, at least 53, at least 54, at least 55, at least 56, at least 57, at least 58, at least 59, at least 60, at least 61, at least 62, at least 63, at least 64, at least 65, at least 66, at least 67, at least 68, at least 69, at least 70, or more contiguous nucleotides complementary to the target nucleic acid molecule, such as 20-70 nucleotides, 20-60 nucleotides, 20-50 nucleotides, 20-40 nucleotides, or 20-30 nucleotides.

Primers are short nucleic acid molecules, for instance DNA oligonucleotides are 10 nucleotides or more in length, which can be annealed to a complementary target nucleic acid molecule by nucleic acid hybridization to form a hybrid between the primer and the target nucleic acid strand. A primer can be extended along the target nucleic acid molecule by a polymerase enzyme. Therefore, primers can be used to amplify a target nucleic acid molecule.

The specificity of a primer increases with its length. Thus, for example, a primer that includes 30 consecutive nucleotides will anneal to a target sequence with a higher specificity than a corresponding primer of only 15 nucleotides. Thus, to obtain greater specificity, probes and primers can be selected that include at least 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70 or more consecutive nucleotides. In particular examples, a primer is at least 15 nucleotides in length, such as at least 15 contiguous nucleotides complementary to a target nucleic acid molecule. Particular lengths of primers that can be used to practice the methods of the present disclosure include primers having at least 15, at least 16, at least 17, at least 18, at least 19, at least 20, at least 21, at least 22, at least 23, at least 24, at least 25, at least 26, at least 27, at least 28, at least 29, at least 30, at least 31, at least 32, at least 33, at least 34, at least 35, at least 36, at least 37, at least 38, at least 39, at least 40, at least 45, at least 50, at least 55, at least 60, at least 65, at least 70, or more contiguous nucleotides complementary to the target nucleic acid molecule to be amplified, such as a primer of 15-70 nucleotides, 15-60 nucleotides, 15-50 nucleotides, or 15-30 nucleotides.

Primer pairs can be used for amplification of a nucleic acid sequence, for example, by PCR, real-time PCR, or other nucleic-acid amplification methods known in the art. An “upstream” or “forward” primer is a primer 5′ to a reference point on a nucleic acid sequence. A “downstream” or “reverse” primer is a primer 3′ to a reference point on a nucleic acid sequence. In general, at least one forward and one reverse primer are included in an amplification reaction.

Nucleic acid probes and primers can be readily prepared based on the nucleic acid molecules provided herein. It is also appropriate to generate probes and primers based on fragments or portions of these disclosed nucleic acid molecules, for instance regions that encompass the identified polymorphisms of interest. PCR primer pairs can be derived from a known sequence by using computer programs intended for that purpose such as Primer (Version 0.5, © 1991, Whitehead Institute for Biomedical Research, Cambridge, Mass.) or PRIMER EXPRESS® Software (Applied Biosystems, AB, Foster City, Calif.).

Sample: A sample, such as a biological sample, is a sample obtained from a subject. As used herein, biological samples include all clinical samples useful for detection of fetal aneuploidy, including, but not limited to, cells, tissues, and bodily fluids, such as: blood; derivatives and fractions of blood, such as serum; urine; sputum; or CVS samples. In a particular example, a sample includes blood obtained from a human subject, such as whole blood or serum.

Sequence identity/similarity: The identity/similarity between two or more nucleic acid sequences, or two or more amino acid sequences, is expressed in terms of the identity or similarity between the sequences. Sequence identity can be measured in Wilms of percentage identity; the higher the percentage, the more identical the sequences are. Sequence similarity can be measured in terms of percentage similarity (which takes into account conservative amino acid substitutions); the higher the percentage, the more similar the sequences are. Homologs or orthologs of nucleic acid or amino acid sequences possess a relatively high degree of sequence identity/similarity when aligned using standard methods. This homology is more significant when the orthologous proteins or cDNAs are derived from species which are more closely related (such as human and mouse sequences), compared to species more distantly related (such as human and C. elegans sequences).

Methods of alignment of sequences for comparison are well known in the art. Various programs and alignment algorithms are described in: Smith & Waterman, Adv. Appl. Math. 2:482, 1981; Needleman & Wunsch, J. Mol. Biol. 48:443, 1970; Pearson & Lipman, Proc. Natl. Acad. Sci. USA 85:2444, 1988; Higgins & Sharp, Gene, 73:237-44, 1988; Higgins & Sharp, CABIOS 5:151-3, 1989; Corpet et al., Nuc. Acids Res. 16:10881-90, 1988; Huang et al. Computer Appls. in the Biosciences 8, 155-65, 1992; and Pearson et al., Meth. Mol. Bio. 24:307-31, 1994. Altschul et al., J. Mol. Biol. 215:403-10, 1990, presents a detailed consideration of sequence alignment methods and homology calculations.

The NCBI Basic Local Alignment Search Tool (BLAST) (Altschul et al., J. Mol. Biol. 215:403-10, 1990) is available from several sources, including the National Center for Biological Information (NCBI, National Library of Medicine, Building 38A, Room 8N805, Bethesda, Md. 20894) and on the Internet, for use in connection with the sequence analysis programs blastp, blastn, blastx, tblastn and tblastx. Additional information can be found at the NCBI web site.

BLASTN is used to compare nucleic acid sequences, while BLASTP is used to compare amino acid sequences. To compare two nucleic acid sequences, the options can be set as follows: -i is set to a file containing the first nucleic acid sequence to be compared (such as C:\seq1.txt); -j is set to a file containing the second nucleic acid sequence to be compared (such as C:\seq2.txt); -p is set to blastn; -o is set to any desired file name (such as C:\output.txt); -q is set to -1; -r is set to 2; and all other options are left at their default setting. For example, the following command can be used to generate an output file containing a comparison between two sequences: C:\B12seq -i c:\seq1.txt -j c:\seq2.txt -p blastn -o c:\output.txt -q -1 -r 2.

To compare two amino acid sequences, the options of B12seq can be set as follows: -i is set to a file containing the first amino acid sequence to be compared (such as C:\seq1.txt); -j is set to a file containing the second amino acid sequence to be compared (such as C:\seq2.txt); -p is set to blastp; -o is set to any desired file name (such as C:\output.txt); and all other options are left at their default setting. For example, the following command can be used to generate an output file containing a comparison between two amino acid sequences: C:\B12seq c:\seq1.txt -j c:\seq2.txt -p blastp -o c:\output.txt. If the two compared sequences share homology, then the designated output file will present those regions of homology as aligned sequences. If the two compared sequences do not share homology, then the designated output file will not present aligned sequences.

Once aligned, the number of matches is determined by counting the number of positions where an identical nucleotide or amino acid residue is presented in both sequences. The percent sequence identity is determined by dividing the number of matches either by the length of the sequence set forth in the identified sequence, or by an articulated length (such as 100 consecutive nucleotides or amino acid residues from a sequence set forth in an identified sequence), followed by multiplying the resulting value by 100. For example, a nucleic acid sequence that has 1166 matches when aligned with a test sequence having 1154 nucleotides is 75.0 percent identical to the test sequence (i.e., 1166÷1554*100=75.0). The percent sequence identity value is rounded to the nearest tenth. For example, 75.11, 75.12, 75.13, and 75.14 are rounded down to 75.1, while 75.15, 75.16, 75.17, 75.18, and 75.19 are rounded up to 75.2. The length value will always be an integer. In another example, a target sequence containing a 20-nucleotide region that aligns with 20 consecutive nucleotides from an identified sequence as follows contains a region that shares 75 percent sequence identity to that identified sequence (that is, 15÷20*100=75).

One indication that two nucleic acid molecules are closely related is that the two molecules hybridize to each other under stringent conditions, as described above. Nucleic acid sequences that do not show a high degree of identity may nevertheless encode identical or similar (conserved) amino acid sequences, due to the degeneracy of the genetic code. Changes in a nucleic acid sequence can be made using this degeneracy to produce multiple nucleic acid molecules that all encode substantially the same protein. Such homologous nucleic acid sequences can, for example, possess at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 98%, or at least 99% sequence identity determined by this method. An alternative (and not necessarily cumulative) indication that two nucleic acid sequences are substantially identical is that the polypeptide which the first nucleic acid encodes is immunologically cross reactive with the polypeptide encoded by the second nucleic acid. One of skill in the art will appreciate that the particular sequence identity ranges are provided for guidance only.

Short Tandem Repeat: a pattern of two or more nucleotides are repeated and the repeated sequences are directly adjacent to each other. The pattern can range in length from 2 to 16 base pairs (bp) (for example (CATG)_(n) in a genomic region) and is typically in the non-coding intron region. A short tandem repeat polymorphism (STRP) occurs when homologous STR loci differ in the number of repeats between individuals. By identifying repeats of a specific sequence at specific locations in the genome, it is possible to create a genetic profile of an individual. There are currently over 10,000 published STR sequences in the human genome.

Single nucleotide polymorphism (SNP): The polynucleotide sequence variation present at a single nucleotide residue within different alleles of the same genomic sequence. This variation may occur within the coding region or non-coding region (i.e., in the promoter region) or an intergenic (between genes) sequence of a genomic sequence. Detection of one or more SNP allows differentiation of different alleles of a single genomic sequence. All common SNPs have only two alleles.

SNPs within a coding sequence will not necessarily change the amino acid sequence of the protein that is produced, due to degeneracy of the genetic code. A SNP in which both forms lead to the same polypeptide sequence is termed “synonymous” (sometimes called a silent mutation)—if a different polypeptide sequence is produced they are “nonsynonymous”. A nonsynonymous change may either be missense or “nonsense”, where a missense change results in a different amino acid, while a nonsense change results in a premature stop codon.

Standard control: A value reflective of the ratio, or the amount or concentration of a fetal genomic sequence located on a chromosome relevant to a particular chromosomal aneuploidy (such as trisomy 13, 18, or 21) over the amount or concentration of a fetal genetic marker located on a reference chromosome, as the amounts or concentrations are found in a biological sample (for example, blood, plasma, or serum) from an average, healthy pregnant woman carrying a chromosomally normal fetus. A “standard control” can be determined differently and represent different value depending on the context in which it is used. For instance, when used in an epigenetic-genetic dosage method where an epigenetic marker is measured against a genetic marker, the “standard control” is a value reflective of the ratio, or the amount or concentration of a fetal genomic sequence located on a chromosome relevant to a particular chromosomal aneuploidy (for example, trisomy 13, 18, or 21) over the amount or concentration of a fetal genetic marker located on a reference chromosome, as the amounts or concentrations are found in a biological sample (such as blood, plasma, or serum) from an average, healthy pregnant woman carrying a chromosomally normal fetus. In some embodiments, a standard control is determined based on an average healthy pregnant woman at a certain gestational age.

Subject: Living multi-cellular vertebrate organisms, a category that includes human and non-human mammals (such as laboratory or veterinary subjects).

Unless otherwise explained, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. The singular terms “a,” “an,” and “the” include plural referents unless context clearly indicates otherwise. Similarly, the word “or” is intended to include “and” unless the context clearly indicates otherwise. It is further to be understood that all base sizes or amino acid sizes, and all molecular weight or molecular mass values, given for nucleic acids or polypeptides are approximate, and are provided for description. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of this disclosure, suitable methods and materials are described below. The term “comprises” means “includes.” All publications, patent applications, patents, and other references mentioned herein are incorporated by reference in their entirety. In case of conflict, the present specification, including explanations of terms, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting.

Assessing Fetal Aneuploidy Using a CpG-Containing Genomic Sequence

The present methods utilize an assessment of the methylation status of a CpG-containing genomic sequence in fetal DNA, in order to detect a fetal anuploidy. Basic texts disclosing the general methods of use include Sambrook and Russell, Molecular Cloning, A Laboratory Manual (3rd ed. 2001); Kriegler, Gene Transfer and Expression: A Laboratory Manual (1990); and Current Protocols in Molecular Biology (Ausubel et al., eds., 1994), which are incorporated herein by reference. Any one of the sequences identified herein, including SEQ ID NO: 1-68 and 83-85 and portions thereof, are examples of sequences that can be used to detect fetal aneuploidy.

In some embodiments, the methods include (a) selectively purifying fetal DNA from a maternal biological sample using the methylation status of a CpG containing genomic sequence, wherein the CpG-containing genomic sequence is at least 15 nucleotides in length, comprises at least one CpG dinucleotide, and is within a region on chromosome 13, 18 or 21. In some examples, the CpG-containing genomic sequence comprises at least 15 nucleotides of a nucleic acid sequence set forth as any one of SEQ ID NOs: 1-68. The fetus is genotyped using the purified fetal DNA to detect aneuploidy in the fetus. The methods can include the use of more than one of the CpG-containing genomic sequences. Thus, the method can in the use of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65 or all of SEQ ID NO: 1-68 and/or SEQ ID NO: 83 (or a portion thereof). Thus, the methods can utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides of one or more of SEQ ID NOs: 1-68 and 83.

In some embodiments, the method comprises (a) determining in a biological sample taken from the pregnant woman the amount of a methylation of a CpG containing DNA of fetal origin, wherein the CpG containing DNA is located on a chromosome relevant to the chromosomal aneuploidy or within a section of a chromosome relevant to the chromosomal aneuploidy, and wherein the methylation of the CpG containing DNA of fetal origin is distinguished from its counterpart CpG containing DNA of maternal origin due to differential DNA methylation; (b) determining the amount of a genetic marker of fetal origin in the sample, wherein the genetic marker is located on a reference chromosome, and wherein the genetic marker of fetal origin is distinguished from its counterpart of maternal origin in the sample due to difference in polynucleotide sequence, or the genetic marker does not exist in the maternal genome; (c) determining the ratio of the amounts from (a) and (b); and (d) comparing the ratio with a standard control, wherein the ratio higher or lower than the standard control indicates the presence of the chromosomal aneuploidy in the fetus. Typically, the standard control value approximates the expected gene or chromosome dosage or ratio in the human genome, although slight variations may exist depending on the specific methodology used in the detection method. In some cases, the sample is maternal whole blood, serum, plasma, urine, amniotic fluid, genital tract lavage fluid, placental-tissue sample, chorionic villus sample, or a sample containing fetal cells isolated from maternal blood. In other cases, the sample is any sample that contains fetal nucleic acids. In some embodiments, step (a) includes treating the sample with a reagent that differentially modifies methylated and unmethylated DNA. Such reagent may comprise bisulfite or a protein or chemical that binds to DNA based on methylation status; or the reagent may comprise a restriction enzyme that either preferentially cleaves methylated DNA or preferentially cleaves unmethylated DNA. In some embodiments, more than one methylation marker or more than one genetic marker may be used. Thus, in some specific non-limiting examples, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or 15 genetic markers can be utilized.

Fetal DNA co-exists with maternal DNA in the acellular portion of a pregnant woman's blood (for example, serum or plasma). DNA from fetal origin and maternal origin can be distinguished to ensure accurate results in fetal DNA-based diagnosis. U.S. Published Patent Application No. 2003/0044388, incorporated herein by reference discloses that fetal and maternal DNA can be distinguished by their different methylation profiles. U.S. Published Patent Application No. 2003/0211522, incorporated herein by reference provides methods wherein methylation markers can be used for prenatal diagnosis.

In additional embodiments, step (a) or step (b) may include the process of amplification of the methylation marker and/or the genetic marker, especially the methylation marker and the genetic marker of the fetal origin. As one example, the amplification is by a polymerase chain reaction (PCR), such as a methylation-specific PCR; or the amplification may be a nucleic acid sequence-specific amplification.

Fetal DNA can be hypomethylated relative to adult DNA reflecting transcriptional silencing of specific genes expressed early in development. One means of generating fetal-specific PCR products is to identify loci that are unmethylated in fetal DNA and methylated in adult/maternal DNA. Another means to detect fetal-specific DNA is to identify loci that are methylated in fetal DNA and unmethylated in adult/maternal DNA. Loci of this type are differentially reactive with bisulfite such that unmethylated Cs in DNA undergo oxidative deamination, resulting in C to U transitions. Methylated Cs are not reactive with bisulfite, and consequently, are unaffected. Bisulfite treatment of fetal and maternal DNA present in maternal serum will create primary sequence differences between fetal and maternal loci that exhibit differential methylation. However, restriction enzymes that differentially recognize and clear unmethylated DNA can also be used. In other embodiments, the method for selective enrichment of fetal DNA requires the use of the methyl-CpG binding domain of human MBD2 protein, which is coupled to paramagnetic beads, for example DYNABEADS® M-280 Streptavidin, via a biotin linker. Without being bound by theory, the high affinity of the MBD-biotin protein for CpG-methylated DNA provides greater sensitivity than antibody binding, while the use of the DYNABEADS® provides a simplified, streamlined workflow.

In one embodiment, the DNA is amplified using quantitative PCR and primers selected to amplify sequences on a potentially abnormal chromosome. Control quantitative PCR with a second pre-selected primer is conducted on a normal or control chromosome (i.e., a chromosome not having the suspected anomaly) and the ratio of the quantity of the two PCR products are determined, thereby detecting fetal aneuploidies. If the loci of interest are from chromosome 13, 18 or 21, and quantitative PCR strategies are employed. In some embodiments, real-time PCR is utilized and chromosome copy number are determined. If the loci are also highly polymorphic such that both alleles can be discerned, chromosome aneuploidy can be readily revealed. Other amplification methods can also be used, such as Loop Mediated Isothermal Amplification (LAMP).

In some embodiments, methods are provided for detecting fetal chromosome aneuploidies by treating DNA isolated from maternal serum with bisulfite or restriction enzymes and then performing quantitative PCR on the sample with a primer pair homologous to a test chromosome sequence that is differentially methylated in maternal DNA and in fetal DNA, where the primer pair only primes bisulfite treated unmethylated DNA or restriction enzyme treated unmethylated DNA. A “control” quantitative PCR is conducted with a primer pair homologous to a control chromosome sequence that is differentially methylated in maternal DNA and in fetal DNA, where the primer pair only primes bisulfate treated unmethylated DNA or restriction enzyme treated unmethylated DNA. The ratio of the quantity of PCR product produced for the test chromosome is compared with the control chromosome, thereby detecting fetal aneuploidies.

In some examples, the mother and the fetus are human. However, the methods can be used in other mammals, such as, but not limited to, non-human primates. In some examples, the subject is human and the fetus is between about 10 and about 14 weeks of age, such as between about 11 and about 13 weeks of age. Thus, the fetus can be 10-14 weeks of age, 11-13 weeks of age, or 10, 11, 12, 13 or 14 weeks of age. However, the fetus can be of any age. In some examples, the mother is in the first or second trimester of pregnancy.

The methods disclosed herein can utilize the following nucleic acid sequences, or a CpG containing nucleic acid sequence within 100 kilobases (kb), 50 kb, 25 kb, 10 kb, 5 kb or 1 kb of these sequences.

In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides or all nucleotides of at least one of the following nucleic acid sequences:

SEQ ID NO: 1 ACAATATGGAAAACACAGCTGTAACCCATACACATTCACACCAGCACAAG CTTCTTCCATCCTTCCTGGAGAGAGACAAAAACAGAAGACACAGAAAGGA AGGGCAGGATCAGGGACAGCAGGTTCGTGGGAGGGACTGTTCGTGGGGGA ACC

GCAGGGGAAGAAAGACAGGAAGGGGAAGAAGGGGAAAGAGAG GAAGTGGGGTAGGGCAGAGGGCCCTGGGCTGTGCACTCCCATCTCACACT TGTCCCCAGAGCAAGGTCTTTAAGGCCAGACTCCAACCCAGGAGCAGGGA GGGGGGCAAACGCCCCTGTAGCCGCCCTGCACCCTCCCAGGAGGGGGAGC ACAGGCTGTC SEQ ID NO: 2 CCACAACCTGTCAGAAATGCCCCCAAGCCCAAAGGCGTCGAGAGAATGGC CAGGTTGTTTCAGATTGACACATATCCTAATGTACAAGTCAGCCCACACA CCCCACGTGCACTGAGCGTCTCTTGTTGTTCACCCCAAATAAACTCTG C

GAACTGGGGCGGGACTCGCAGGGGCGGAGAAGGGGGGAGACGGGC AGAGGGCAGAAGTGGATGGTGAGAAGAGCCAATGGAGGGGCCCCGTGAG AGTGAGCAAGGCTGCACCCCT SEQ ID NO: 3 TGATAACACTGGGGAGAGTTAACTTTTTCACCTCTGTTTGTTGATATGC CCCTTTGTGCTCCGTATTCACAAAGGGGCACCTCAACAAGCCCATCATT TGTTAATGAATGCCTTTACTTTCATCGCCAGCAAGACATTTTCATAAAC CCACCATCTACTTTGCAGTTCTCAAGAGTTGCTTCTCTTAAACTGGTGA GGACGCGGCTAAGCCCTGGAAATGAGTCCAGATTCTCACGGTGGCCCAT AAACACTGCTGTTTCCTCCCACCTAGGAAACCCGCAGACCTGCAGAACC TGGCTCCCGGAACAAACCCTCCTTTCATGACTTTTGATGGTGAAGTCAA GACGGATGTGAATAAGATCGAGGAGTTCTTAGAGGAGAAATTAGCTCCC CCGAGGTAGGCCTCAGAAAACCAGTGTTCATAACTTGATTGTCACTTTC CCCCACTAGTAGTCAGTTCTAAAGCTCTGGGCAGTGTGTGTGTGTGTGG TTTTCTGCAGCCCACGGTGCTCACTTCCTTAATCATAACCCTGGTGTAA CCAGATTAGAGTTCGGGGACCTGGGTTTCATTGTGCTGCACCTGCAGCT TGGCAATCACAGT SEQ ID NO: 68 CCTTTGTTCTTGTTGGCATCTGTGTAAGAGAATCCAGGGCCTGAACCAT TGTCCACTCAAACAGACCATACACACCTGGTCCAGTTTTGTGCATGCCT CCCTTTTCCACAGTGTGCCACTTGCTATAGTTCTGAACAAAAACTCCCT TGCCCTTCGGAGCTTTATTTATTTTTAATTTGCTCTGTCATTGCATTGC ATGCAATAGAAGCTTCCTGGTGGAAGCTCAATGTTCTGCTCAGTCCCAG ACACGTTTTCAGCCACTGTATCATTGCCTTAGGTTGTGGTTTCCCCAAA GCAGCACCGGAGGTAAGGGCTTGTGTGCAGGAGTTCACTTGGGAGGTGG CTCTAGGAAATAGAAGCGAGTTTCCAGGAAGTGTGGGATGAATACGGGG ATGGGGTGGGGGGCGGGGAGGAATCCAATATGAATATATAATCTCATAT TGAGTATAAAAATCCAATATGAGTATGTTTTCCAGACTGCTGCTAAGGA GAATGGTGAATTATTCTACTGCGACCTTTTGAGGGTCCACACAATGCCT CCCAAAACTATCTACCAGAGGGTGGATAGGAAGCATTGATCCATGGCTT ATATTCCCCATTG SEQ ID NO: 4 ATCAGAGTCGCCCTTGACCTCAACCCTGCCCGAGAAGGAAGTGCTGGTG CAACCCCAGCCCAGCTGCAGGAAGTGGTACCTGTCACCAAGTCCCCTGC ACAGGGGAAGCAGGGGGCTGAGGGGGCAGGACCAGGGGGACGAGGTCAT CCTTCCCCGGAGAACCCCTCAGGGGCCGGGCGCCCTTCCCTCCCGGGCA CCAAATGGACACAGCTAACAAGAACCACACTTCACGGTGAGCAAAGCTC TGAACATTCAGGCTCTGAGACACGAAAGCGGCGTCAGAAGAGACCTGCA GCAGATCCGGGCCAAATCACACACACCCTTTCACAGAAGTCGAGGACAG GAGAACAGGAGCAAACACAGGAAAGGAAGAGGCCAGCCTGGTGGCTGAC GCCTGCAATCCCAGTGTTTTGAGAGGCCAAGGCAGGAGAATCACTTGAG GCCAGGAGTTTGAGAGCAGCCTGGGCAACACAGTGAGACTCCTACCTCT ACAAAAAATAAAAATAGAAAATAAATTAGCCAGACATGGTGGCATGCAT CTCTAGTCCCAGTTACTCAGGAGGCTGAGGCAGGAGGATCACTCGCGCC CAGGAGGGAGAGA SEQ ID NO: 5 CTCTGAGATGCGTCGTGTAGTAAACTTCTCAATAAGGCGTAGTTTATGT TCAAGAGAGAAATTCTCTTTGTCACTTAGCATAAACCTTGTAGCTAGCT TTCTGAATATTTGTATCTCAGTAGAAGAGTTAAATGCCTCATTCAAGTA TGTTTTCAAAATAAAAATTGTAAATAAAATCACGTGATGTTTATATATG AGAAGTCACCAGCTTTTCATTCAGAGTTCCCCCGTTTCTAGAGGTTGGA CCAGCCTCAATGATCGTGGGGAACCTGGTTGCTGGGAAGAGAATCGCTC AGGCTTCCGGGAGAGAGCTCGCCCACCTGGAGGACAGCGACCAGGCACG GAAGGTGACAGGCCAGTTCCGGGGACGGGTGGACGGGTGTCTGTGCCCC GGAGGCGCCAGTGAGCAAGTCGCCCTCTCGTGCAGTTCCTGTTCCTGGC TGACGTGCTGCAGTGGCGTGCCCACACCACTCCTGACCACCCGCTGTTC TTGCTGCTGAACGCCAAGGTGAGGCAGTGTCACGCCCACGGGGCTTGGA AACACCTGTGGGCCGGTGGAGCCCTTTGCTTGTCTAGTTCATGGTGCCA GTGTCCTGGTTGT SEQ ID NO: 6 AAAATCTTTTTTTTTTTTTTTTTTTTTTGAGATGGAGTCTCGCTTTTGT TGCCCAGGCTGGAGCGAAGTCTCTTAGTTTCCTCCCCACGGTTTCGTGC ACTAGACCCCGAAGCAGGCAAGCTGAGCATCTTTATCCCCATTTTTCAG AGGAATGACTAGAAGTCAGGGTTTGCCCAAGGTCAAACAACTAGCTGGT TGCAAAGTAAGAATTGGAAGCCACCCATGTTATTCCTTCCGCTACACCT CCCTCCAGAGACAGGGCTGGCCAGCATCGCACGGAACAGGAAATTGAAA TGGCTCCCGGTAAGGCAGCGAGCCTGCCAACCACCGAGAGAAGCTGACA AGTGACCCAAACCCGCCCAGAATTTAAAATGCCTCCTCAGAGGAGTTGC CGACTAACCTCCTCCCACCTGCTGCAGTGAAGAAATAAGTTCCAAGAGT CTGCAACCCACCATGCCTGTTTTTCCACGGGAAGGACCAAGTTAGAAAG GAAGCTTGAATAAGTGGGATGCTGTTGAAGAACTAAGATGTAGAAGCAG TTTCCCAATATGAACTTACTAGCTTTTTTCCCACTCCTATCACATCGCC ACTCCCCCCACAC SEQ ID NO: 7 GCTCCTTTTTGGGTAAGGTCTGTTGCTTCTCTAGGAACAGTGACGGTGG CAGAGCCCGTGGCCCCTCTCTCCTGTCCCAGAGCCAAGCTGTTTCCTCT CCCCACTCCCGGGCACCCTGCGGGCAAGTGAGGGGGGCCCACTCTGCCC TGGCCTGCCCCACCGCCCCATTTGCTGGGTTGTCCTCAAAGCACACGGT AAGCACCCCCGCCCCCGCCCCCCACACACGTACCGCTGTCAGCCTTCTT GCTCGTCACCTCCATCCAGGGCACATCCGCCCCTCTGGGTGCTGTGAGC CTGTTGCCGGCGCGGTCCCGCTGCTCCTCCTTCTGCTGCCCTGCACTGC CGTGGCACAACCCTCCCTCCGGGTCTCTGCTGAGCCCTCCAGGCGCTCA GGTCTGCCGTCTGGTTGCAGGTGTTTTATAGAGTGCAGCTTTACGCTCC CACTCCAGTCATCTCCACGTTGGTGTCCGTCTGTGTGTCCTCTCTGCCT TTAAGTTCTGCCTCTGTGTGACACAGTTTCACAGTTTCTGTGACCAAAA CACAGGTTTAGTCGCTTGCTGCTGGCAGAGTCCAATTAACAAGAGCACG TCGGGTATAAAGA SEQ ID NO: 66 CAGAGACGAGAGACACTTTCTTTGTACATGTCCCACAAGCACAGTTCCA GGATTTTGGCACTAAGTAAACAAATAAAAATATGCAACAGACATAAGAG ATAATAGTAATGTGTATTGAGAAATATAATTTTATATAGTTGTTCCTTT TTCCCAAGATTCTTTATTAATATCACCAATAGTTATTACTAGAAAACAC TTTCAGAGCTAGAAAGTTGCCAGAAACATTTCTAATTGACTACTGTTAT AATTAATATTTTGAAATGCTGAGACATTTGCTAGGGTGGACAGCTCCTT CAAAACCCGGCCGTTATCTGACGAAAGAGCCTAGGCTCAAATAAGAATT AAACACAAGTTGGAAGTAAGGTGAGGCACAGTGGAATTTTTTTAGGATG GATATAGTTTTCAATAACCTTAATTTGGAATTTTTCCTTTGGGATAATG ACTTTGAGTCTATAGAAATATTGTATGCATTATAGACGAATTGATTTTT TAACTAAATTCTGAAAGGCTTAAGTAAAATGATTTGATGATCAAGTCAG ATGCATTTCTAAGGAAGTGAGGATCACATTAGACAGAAAGTTTGGGTTT GGTGTATAATAAT SEQ ID NO: 83 CAAATTCTTCCCAAGTACTGTTTCCTTTCCTCAATTCCTGGCCTAGCAA GTCTAGAAAGAAAACAAAAAGAATGTAAAATGTTCTTGGTTGACTTTAC TCTTAATTACTAAAAAGCAAACAGAGAAAATTAAAATCAAACACATGCA AAAAATTCTTCTAGAGCCTTGCACACAATGCCAGTTCTTGAAATATTTC ATAAAGCAAAGCTAATGAAATAAACAAAGACGTGGCTGAAAGGATATGC ATTGTACTGTGCTTATGGAGCCACATTGCTCACTGCATCTCTCGCTCCA CTGCCGCCGGGCTCATCTGCCAGAAGCCTGTTCCTGAGCTGATTGGGGT TCTGGTCCAGGGGTCCCAAGGAGCGAGGCCCAAGCTCAGGAGGACAAAG AACGACCACCTGGAAAGTGGCAAAAATCTGTAAAAAAATAAAATCTGAG TGGGCCCAAGGGGCACCTGGTCTCAAGAGCAAACGCTGTGTCCAGAGCC TCATGTCCGGAGGCCCAGCCCGACTCCCTGGCTCTTACAGCCCCGAAGC CCAGAGACCACCCCAGCCCGACTCCCTGGCTGAGACTTCCCGCCCGGAT GCCGTGAGATCGT SEQ ID NO: 8 ATGTGAGAACCCAGCACCAAAACTGGGCTCACGGATCAACAAAAATAAC CCGGGCCTCACCGACCAAAATCAAGTAGAATAGCGGTTGGGTCAAAGGA GAGAAAAATAGGCTTGGTTGCTAACC In some embodiments, the methods utilize one or more of SEQ ID 1-7, 66, 68 or 83. In additional embodiments, the methods utilize all of SEQ ID NO: 1-7, 66, 68 and 83.

These nucleic acid sequences can be used to purify fetal DNA and/or detect aneupolidy of chromosome 21 (SEQ ID NOs: 1-7, 66, 68 and 83) or chromosome 18 (SEQ ID NO: 8). In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides of these nucleic acid sequences.

The following nucleic acid sequences are less methylated in fetal DNA than maternal DNA, and can be used to detect fetal aneuploidy of chromosome 13. In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides or all nucleotides of at least one of the following nucleic acid sequences:

SEQ ID NO: 9 TAAATATCTGTGAGAAATATTTGTGAAAGTATATTATGGAAAAAATGGA ATATGCATGTAAACTTAGGCTATGTTGAGTAAAATAAAACTAATGTTTT AAATATGAAGAAATGAACAGTTGCTCAATGCTTGTTTCTCTACACATGT GCAGGAAGTATATAATTCAGTGCTGTACACATATCACATTGGAGCATTA ATCACAGCCGTGTCCCACTTTACCCAAACATGGCCACATAGTCTCTTAA TCCAAGCATTTGGGAAACTACTAGCAATCATTTAGAGTGGAAACATAAT TTGACACCGGTTTAGCATTCCATTTGTTTGCTACATCCCTCTTTATGAC AAGAAAGGGAAAAATCATGTAATACTATAATTTGAGGAAATGTAATAAT GCATTCAGGGAGACAGAAGCAGGAAAATTTTGCCTGTGTAGAATATTGT CACACATACATGTATGTGTATGTGTATGTATATATCAGAAAACATATTT CAAAAATAAAAAAGCTATGCTTAGTATACCCCATTGCAAAATCACTTCA TAATGAAAGCACAGACCATGTACAACAAATAAGTGTGACAGAAATGAGT TTGGCAACTACCC SEQ ID NO: 10 ATTTACAACAGCAATAGGTAGCAATAGGTCTCATGACTTTACTTCTCTA ATGGATTGAAGAAAAACCAGTGAATTTTAATTTGTCCTGCCTTTGCTTT TTGTGAAATGAGAACAACTTACAAGCCCTTCAGATATTAGAGCTAATAC TAGAAATCCTCTGGTGAGGTTTTTATTACTTATGTTATATTTTACAATC ACAAATTCTCTATTTGCCTCTTTTAAAAAAATGTTTTCTAGGTGGGAGT CGGTGGCTCAGGTAAGAGATACTGCCTCATGTAACTCTCTGGGTATGAC TTTCTCCCGGATTTAAGGGTAGCAATAGGTCTCATGACTTCAGTTCTCT AATGGATTGAAGAAAAACCAGTGAATTTTAAATTGTCCTGCCTTTACTT TTTGTGAAACGAGAACAACTTACAAGCCCTTCAGATGTTGGAGCTAAAA CTAGAAATCCTCTGGTGAGATTTTTATTACTTCAGTTATATTTTACAAT CACAAATTCTCTATTTGCCTCTTTTAAAAAATATTTTCTAGGTGGGAGT GGTGGCTCATGCCTGTAATCCCAGCACTTTGGGAGGCCGAGGCGTGCGG ATCACCTGCCTGA SEQ ID NO: 11 TTCTATTCCTTTCCTTATAAATCCAAGCAATAGTTTCATTCTTTAAAAA TGCATAATGTGAAAATAGCATTAGGAAAGCTGCCTTGAAATATGGATAC TAAATGCATCCCACTGGGCAACTTCAGCAAACCGCTGGGTCTTCCACCA CAGTTAAAATAGCTCCTGCTGTCCCCGGGGCAGGAGTGGCTTAAGAAAG CATTTAATCCAGGAGTGCGTGTCTGGAGCTTTGTGTTAATCAGATTCCA TATGACTGAATGACCTTTGTTTTCCCTCTGGTGGAATCGTGAACATTTG GGAAAACCGGTTTGCTTTTAGTGAGTGTTGCAGGGTGCAAATGAAACTG TATTCAACCTAGGATTCGACTGGGAGAAAAACAGGAGAAAGGCCACAGG ATTGGTGCAAGGACAGCAGGTCAGTGTCAGGGGCTAGGTGACTGGGGAG AAAGCTTGCTGTCCCCTCTGAGTGTCCTCCCCCAAACCTCAGCGTCCCC CCTTGGGAACCCATACCATGGCCCCGGGCAACAGAGGCAGCAACACAAA TAAATAGAAGAACTGTTTCATTAAAACCTCCTCCAGACAAGGCCAGCTC TGGATGCAGTCTT SEQ ID NO: 12 GATGGTGAACTGTGTTCTGGCGGACTTATTTTTAATATACCAATTGTGT GTAGCACAATAGTCATTTCATAAAAGGTCTTCAATGTGTTGTAATCACT GAATGGGAAATAAATTTCCATCCTCTTTTGAAGGGTGCATTTGTGATGT TATACTTGCTGCATATTGTGGTAACAAGCAGTCATTCCCAAAAATGAAC ATGACCCTATTTCATAACAGGATATTGATTTTGCATGCTTAAATTAAGT TTGTATTTATTATTACTATATATCTCTCCAGTTAGTTTCCATTTTTACT TCTAATCCGGTTAAAAACTTACTATATTTTAAAAATACTCTCTGCTATA GCCATCTAATTATTTAAAATAGAATCTCAGGTTATTAGGCAGTGCATTG CTTCCTACATCCAAATTTGAGCTTGAACATTTTGCTAACTCTTTTGGAA TTCAATTTCCAGTTTACTCACCTCTGAAGAAGTATGGATTACTTGACTT GTTCACTAACTTTAGTAGAATTAGAACTCACACTCATGTGTCCTAACAT CAAATTTTCATTGAAGATCATGTGCTGCATGACCTATACAGATGGTCCC CAACTTGAGATGG SEQ ID NO: 13 TTTGCAAAGAATTCTCTAAGAAAGACATTTTCCTGCTTTCGTTTCTGTT TCATGCTGGGTAATGTTGGCAAGAATTATTCATGGCACATGTGAGCAAT TCAAAGAAATATTGTAAAAAAAAAAAAAAAAACAAGGCAGCTTTGCAGA GGTGCGCTATCTGCTTGATGACTTGGCATGCTGCCTCTGGTGCTTGGCA TAGCACCCTAGCTGCTGGCACAGGGGAAGTTACATATACTTGCCATTGG GCCTCTACTATGCTACCTGCTGTGCACGATCAATATCAACCAACTGCAT AAACAACCGGATGAACCTTGTATCTGAGGGACAGCAAATAGCATTTGAA TTATTTTACATAAATCTGAAAATGTAATAGCGGTTGATGTTCCTATTAG TATTATATCTGAGCACGATGATCATAATTGAGTAACATTAAATTTAGTT TATTGAACAGCAGTCCACTGCCCGGTTTACTGTGACTACGATCTGTGTA ATGAAACCAGCAATATGAAAAATTCTCTCAGTTGGTACACTTCCTGGAG AGGAGCCAAAGTATTTATTGCTATTTGTGCAATTAATGGCCGTATCGAT TTCTTTTTTTTCT SEQ ID NO: 14 TTACCAGGACCTCACTATAGGAAGAAAAAAAAAGTAAAGCAACCTCGCA GGTATCTTTGCTGGTTAACATCATAGAGTATGAAGGGTATCTTGATGTG ATCCATTTTAAGCTACAAAGTTTCTTACAGTCATACTCAAAACTGGCAA AATACAGGACATCATACACATTTTCATATTTTATTCTAATGTTTATTCT GAGGTCAACAATATAAATTAGTTTCTGAGATGCGCAGATAAATTAAAAT TCCATGCAGGTGACCATAGACATACCCCTACTATGTGTATCTGTCTAAA CTATAACCGGAGAGGACTACAATTAATCCCTTAAGCCCTTTATCTTCTT TTCGTCTCCTGCTTGGTTCTACGTAAACACCTTTGCTGAACTGGAAGAT CCAACCAACTTATACGAGCTTCTTGGATGCGAATGAAAACCTCGTGAAT TGCCCAGCAAGTTGACATTCCTTTCTAGATCCAGCACATACAACTCTCT CCAGGTGAGCACAAAGAAAGAAGAGATTTGAAGTCAGCGAGGTGCGTTT TATTGGTTCAAAAGGGGAGGTTATTTTTTAAAGGCTTATGGAAAAAGGT AGCTATGTTTGTT SEQ ID NO: 15 TTTGTTAGAAAGTGGCTGTGATCACAAATCAAAAAATACTAACTCATGT ACAAGTGAAGGACCACTGGCCACTTTGGAGGTCTCTTGATCACTCTTGG ATTCCCATCAACCTTAAATAGGATACCAGTCAGTCCCCTGCTGCCTATC CTCAAGAATTCTTTCACTTTGAAGGATGTATAACACCCATAACAACTTA TGAGGCAAACATGTTATACATGAAGGCAACTTTTCCAATATATCACCTC CCCCCATACAACTTAACACATCTGAACTTTCATGGGATTCAAAATACAA AAAAGTCCGGATTCTTTCATATGCACGCAGATCCAATAATAACAAATAA TTAATGATTCTGAGTGTTATTTTATGAGGATGGCATTTTATATCCCTCA TGCTTAGGGCAATTCTAGAAGGAGATATTATCACCATTTCACTGTTGAA ACTGACTCAGAAGCTTATCCAAGAGCACAAATCAACATTAAGTAACAGA GCTGGGATTTAAACGCTGCTGAGAAATCCGAGAGGCTCTGTATTTTTTA AAAACAACTTTTAGAGTAACCTTTTCTTTTCAGCCATGTTAATTATAGG AAGAGACTACAAT SEQ ID NO: 16 CGAGAGTCTGGCTTCCAGTGAAGAACACTTGACAAGGGAGAAAATCTGG ACATTTCTGCCTTTGAGTTTTGCTTAGGCCAATCTTGCAATTCTCCCTC AATCCACGTGGTCACCATCTTCCCACCTAAAGAGCACTCACCTCCTTTG AGAAGCCTGTGCTTGTCCTGACCCCTCTGAGCACACTTTAAAGTTTATG AATTCATTCCTTCCTTTGCCATTTCCAGAAGGTCTTTGTATTTTGCACA AGGACTCTAGTTCTTTGTGCTGGCATCAATTAGAGACTGTTTGTTTTCT GTTTTCCCGGGTTAATGGTAAATGTTTTAAGGGTAAAGATCTTATCTTT ACATAGCATTGATTTTTGAACATTTGATTACTTGCTTATTTATTAAGCC TTTGCTCATTTGCCTTACCATAATCTTTTCTATACCTTCATGTTTGAAT TGTTTTTATGGCTTAAGTATATACATATAATATGTATACATAATTATAT AAAATATGTATATTCTCTTTTATACACTATGAAAACAATTCTTGGAAGC ACATAAAATGTCTTTGCACAATAAAGAAATATTTTAATATTGATAATTC ATAAATTATATTG SEQ ID NO: 17 TGCTCACTTTTTCCTTAATGGAGATTTTGTTCCATGTATGGTAGGTAAT GATCTGAGGCAGGAAGACAAAGAGCAGATAGCATTCAGGGCCTCAAAAG ATTCCCCTAATGTGTACAAACATACTAGATCTGAAGTTCTGGTTCACCA TGGTTCTTCCTCATTAAGCCGCAGATTTCCACTTGGAAAATTCATTGGT AAAGTGCCATGCCTGCTTGCTGCTGATAGGATTTTCTTATTGTCCAGCA GTATGCAAGTATTCAGCCCTCAGTCTCTCAGAAGAGGGGTCTGAATTCC CTTGTTCCGGGGTTGTGACCTTAACCTTGTCCTGAGATTTATAGCCCCA GAGAGGCTCTCCTCCTGATTTACATAGTTCCTGATGTCACTTTGAGCAG ATTTAGTTCCAATCTCTGCAGAACTCTTGACTATGGAATGTGGGAACAC GACGAGCTGTTTGTTTTATACTCCCAAATCCTTGAACAAAAGTTACAGA GTGTTTTTCTATCTTCTCAGAGGAAGAAGGCCCCTCTCCCATTCCCATT CAGTTCTACCAAGCAGCAGCTGTTGCTGTGTGTACTGTGTTTAAAATCC CTTTGTTTTATGC SEQ ID NO: 18 TTCTCTTTCTTAATGATAAAATTACCATAGTACCAAAGTAACTTAGCTT TAGCCTTCTTCTAAAATAGGCATATTCAACCTCAGCAACTGGGCCAGAC AAATTTTTGTTGAGGGAAATGTTCTTTGTGTTTTAGGATATTTAGAAGC ACTTCTGGCCTCTGGCCAATAGCTGCCTAACACTCCTCTCCCTCTTTTC TAGAGTTGCAATAAAAAAATATGTCTAGATGTTGTCAAATCTTTCTTGG GGGGCAAAAGTGTCACCTCTTCAGAACTACCAGTTAGTAGATATGGTAA AAAGAGCCGGGTTGCTTTTTAATTTTATTGCATATTGACAAATTATAAT TGTATATAATTATGGGATACAAAGTGCAGGAGGCTGAATGAAATAGGAG GGATCACCTGAGTCTGGGAGTTCGAGCTGCAGTGAGCTATGATCGCACA GTGCACTCTAGCCTGGATGACAGAGTGAGACCCTGTCTCAAAAAAAAAA AAAAAAAGGATAAAAAAGGAATATGCGATAATTGCGTACCTGCGATAAT ATGATGCAGGTACGCAATGTGGAATGATTAAATCAAGTTAATTAACATA TCCATCATCCATC In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides of these nucleic acid sequences.

In some embodiments, the methods utilize one or more of SEQ ID NO: 9-18. In additional embodiments, the methods utilize all of SEQ ID NO: 9-18 to detect an aneuploidy of chromosome 13.

The following nucleic acid sequences are less methylated in fetal DNA than maternal DNA, and can be used to detect fetal aneuploidy of chromosome 18, In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides or all nucleotides of at least one of the following nucleic acid sequences:

SEQ ID NO: 19 TGCTCACATCCCAATGTCTTAGTGACTTTAGGAAATAAAGCAGCTCTGT AATTTTTTTTCTTACATCCTCGCTATTCAACACCATACTCAGTACATAA ATCCAGATGGGATCCGGACAGTAAAATAAATCTGAATGACAGATAATGT GCTGTCCTCAAAAATGACTCTCCTCCTTTTCAACTGAAAGAAGACATTT GTTTATTTCAGTGAAAACGAGTTCATTATTATCTGTTCCTACTTCCTTG GGAGTGATTATTCTGTCAGATACATGCTAAGTGCAAATTTTCTGCATAG CAGAAACCGGGTCTTGAATCCAGGTGTTCTGATTCTGAGTTTATTTCTC TAAACATTGGTAATGACCATAGAAAGTCTATTTTAAAAGGAAACACAAA CCAAAGACTAATAAAACTATATGCAACTAGAGAGAATTGTATCATGATT TAGATGAGCTCTGCTTTCTACCCTTCTCAATTTAAGTGGGGGTTCATGT TATCCCTTACTTTCATTGTCATTTTCCTTGGTCCAGTGTTCTCCTAGGT CTCCAAATGAAGCTATCACTTGCAGTCTGCAAAACACAACACTGCACTA ATTTAATTCTGTT SEQ ID NO: 20 AATGTTCCTTTTAGATTCCCTTCTTTCCTTTTCCTTCCTTCCTTCCTTC CTTTTCCTCCCCTCCCTCCCTCCCTCCCTCCCTTCTTTCCATGTTGTTC AGGTCACACTCTTCAGCTAGATTTGGGGGAGAAGTGGGCTCAGAAATGT TGGGCATGTGTGGCAGCACCTAAAACGTTATGGAAGCAGGGTGAGTCCC TGAGCATGAAGCAAAGGAGACATGTAAAGGAAGGAATATCCAGTTAGTA TCTGAAGGTGGAACAAAATCATTTAGTTAGTTCTAGCCACACAATCTGG TTTTACCCGGATTGAATAGTTATATGACTCAGGAATCAGAACCCAAACG AATTAATAGGCAAGAAAAATGGCATCCCAGAATCTGTGAAAACTCATAT TGATTGAATTTTAAGAACAAAAAAGGACCTTAGACGTGTCAAAATCAAC TATTCCAAGTCCCTCTGTGGTATTAATGACATCCTGTTAAAACAAAAAC AAAAACAAAAACTTTCAGCAACATCACTTCAAAATTATCCTTTTTTATT TTTGCATAATTTTAATTCATAGAATCTTTTATGAAAATATTTCTAAAAA CTTTCTGCACTTA SEQ ID NO: 21 TGACCTCATATGGCAGCAATCTGACTGGTGATTGCACTGAGAGACAATG CACATGGCATAAGAACAGCTCCTTTACGCTCCTCTTGATGAAGAAGAAC AGGTGGAATACTTCATATACTTTAGATATTGATGTCACTATAAGCAGCT TTGACTTTGAGTTCAGAAAGCAATTGATGGGAATGCAGGCTTCTAGAAG TATAGCTGTCACACAGATTTAGGGTCTGAAAGCAGTTTTCTGGTTTACC TTTTGGCACACAAACCTTCTCTGGTAAGGGACTGAACTTAATTGGAGTC TAAGATCCGGTAGAGAGAGCCATATTGATACTTATATGAATTCTAGAGT TTTGGTGAAAAAAAATCAAAGGTAAGTAAGTGCAAAATAAATTGTTTTG CAGGCATAAATATTCAAACATATAAATATATGTCAGGTATAAATATACA TATTAATATGTGAATATATTATATATAAATATAGTCAGATATAAATATT TAATCATCATAGATTTAGACCGAAGGAGGACAACATAAAGAACATTACT CATTTCTTTGAGTTGCTGGGTATAGCTCAATGATGGTGGATCTTGGGTA CCAGAAAAAAATG SEQ ID NO: 22 TTTCACTAAACATTATGTTAAGTAATGTATGTAGGTTGATAGGTTTATA TGGTACAGTAAGTCATTAATTTTAAACCTTCATATGAATTCAATCAAAT CTTTCATGCTATCTCCTTAGACATTAGAATTATTTTAAATTTGTGTTTT GTTCTGTTTTGTTACTACAAACATTGCTAGGATAAACATTTCGTGCATA CGTGCAGACGTTTCTACACAGTTTATTTATGGTGGCCACAAAGTCTCTA TATCCTAATTAGTGACCTCTGTGTTCTATTATTAGCACAAATGTATATT TTCAAACCGGATCTTGTAGACAACTCCTTGGGAGTCATTAACAGGGAGG GTACCTGATAGTTTTCTTCAGATCATTATTATAAGCAGGGATATCATGC ATGGAGAATTTATAGCTGCTCTATAAGTGGAAGGGCATTGTTCCATTAT TACTAAATATTGCCAAAGTGATCTTCACATAGGTTGCTTCTATGTATAT CCCAACAAGAAATACACGGAAGTTCTCATTACTCCAGATTCTTGACAAG AATTTATATTATCAGACTTTTAATTCTTTTACCAAATGAACAATAATGA TTATATATCTTGT SEQ ID NO: 23 TTTGCCAAAGAACTATGACTTTAGAATATGTGTTATTTACTCTTCCAAG ATACAGCTGAATTGGAGGGGGATTGGGTTGTGCAGATGGCACTTTTTGC ATGTCCCTTGCTCAGATAATTGGATTGTAGAAATAAAAGAAATAATCAG GATGTCAAATTTTAACATTCCTTTTACTCATGGATACTTTGGTGTTGCT CTTATTTCCATAGGCAGAGGGCAGATGATTTTCAGCCCCATAGAAATAG CAGAATGTGCAGGCTACTAACTTCGCTTCCTTGAACTAACATTATGATA TCATCACCGGATTCCTCAGCACAACAGCCTGTTCTTAACTCAGTTCCGA ATGTTTTCTCTCACTATCATCTCGATCACTTCCAAATGTTTTCTCTCAC TATCTTCTTGATCAGGCCATCCCATTCTTAGGTTCTTACTGTGCCTTCT CACTTTGTCTTAAACAGATAAAGTCCTTCAGCTGATTACATTTCAAATG CGTCACCAGGTTGGCCAGAACGCGTCGGTTTCTTCCTATCTTGTTTCTT CCACTTTTTTAAATAAAATAGATTTTTCTAGGAGGACACTATTTAACTT TTCAGCACATATC SEQ ID NO: 24 TTGCTGACGATTCACATTTTATTAGTTTGGTTATGTTTTGTCCTTTTAA AACATTTTCTTTTGAGATGGGGGTCTTGCTCTGTTGCCCACGCAGGAGT GCAGTGGCATGCTCTCAGCTCACTGCAGCCCTGACTGCCTAGGCTCCAG CAATCTTCTTACGTCAGCCTCCAGAGTAGCTGGGACCGCAGGCACTTGC CACCACGCCCCACTAAAAATTTTTTAAATTGTTGCCTTTCTTGAAGTGT TCTCTGCCTGTCTTTGTCACAAAATTTCATTTTTCTCATAGTTAATTTC ATCTCTCCGGTAAGATTTTATTGGTGTTTCTTTTATAACTTTGCAGTTC TTACACCGTTTGGTGATTTTCATGTTTCTTAGAAACTTTAAACCTTTAA CTTCAAACATTAAAATACAAGTCTTTTAAGTACATGAGTGCTTAGAAAT GTACATAATGTTTATATACACTTATGCCTTACATTAAAGTCCAATATGA GAAATACATGTTTAACATTCAATAATAATTTTAAAAATTTGAGAAATAA ACTCTCATAAATGCACACATTTTTATAAACTTGCTACTTGTCTGCTGTT GATTTTAACATTT SEQ ID NO: 25 GCAGAAGCTTTTCCTCTCCTGCCCTGACGGCGAGTTTTCTCCATAACTT GCTCCCGGGGTTCCCCTGCGGGTGTCCTCTCCCATCCAGACTGGCTGGC CATTCCCGGGACTAGACGGTGCTTAGGGCGATCGGGAGCTCTGATCCGG CCTGATTTTTCTGATCATCAGCTTCCTTTCTTTTTCATACTCTGATTCT AAAGATAAAGATAGAGCCAGTTTCTCCCCCTTTGGTGTTTCAAATTCCT TTCTCATGACTCTTCAGGCAGTACAGTGAAGAGATTAAGTGCACGACGT GGAATTCCGGCCTGTCTCCTTAATAGCCTTACGATCTACCTCACGGAAG TGTTATGAGGGTGGAATGAGTTAGTGCACATAAAGCCTGTAGCATGGTG CTTGGCCCAGAATAGGCCCTCAGCGAATGTTAGTTATTATGGTGATGAT TAATACTTCAGTTTCTCTGTGCTCAGCAAACACCACCTCCCTGTGTGGG CACTGCATAATCCCCTCGCCACATATATTCAAGGTCCTACCCCTGTCTG CTTATGCTATGGTCTCTAAGGAGGAGCAATGGGGGATGCCTGTCACCTT CCAAGACTTTTAT SEQ ID NO: 26 TTGTGTTATTAGTAGAGACGGGGTTTCACCATGTTGGCCAGGCCGGTCT CGAACTCCTGACCTCAGGTGATCCACCCATCTTGGCCTCCCAAAGTGCT AGGATTACAGGCATGAGCCACCATGCCCAGCCACATAGAAAGATTTTGA TTAGATATTAGGAAGGATTTGGGCTACAACAAAAACTTGTTGAACGATT AAGTCAAAGCATACTCCTTTGAATACTGAAAATGTTTGCTGAGGTTGTC TCAGTTTTGAAGGACTGCTTTCCATTCCATTTTTCTTGTTATCTTCTGA TCTAAACCGGTGATAAATTTTATGCTGTCCGATGACAGGCAGGAATGGT AACAGAACTTGCAGATAATAGGTTGCTTACCAAAAGTTATAGATTGACC AAATGAATTTGTTTTCTAAGAAAATGGAGGGCATTAATATAAAACTCAA ATTCCTTGGAGTTACTCAAAGCCCTCAAGTATATTTGTCCTTGTCCATT GCCATGGATGTTTCCAAAATGTAAGCTTTGATGAGAAGTGGTAAAGAAA ATAAGGCATTCG SEQ ID NO: 27 CCTTAGTTTTTTGCTGTAACCCAGCTCATGGCCAAGGCATCGTTGCATA GATTTGAGACACTAGAAATCAAACCTGAACTGCCGGAAGTGCAGATGCC GCAGCAGACCTCCTGGTCAGGCTTCAAATCCCACCTTCCACACCTGTTC CTGGGAGATGAAGTTTGTACCCATGGTCATCTGTCCCTCTGCCACTCCA TTCAGATGTGTCCACGTCTCCATGGCCCCTCCATCCAAGAGAAAGCAAC ACACATGTGCAACCAGGAAACATACAAAAGTGCCTTGCAGCCTTGTGGA TCCTTACCGGCCAGATAGCCATGGGCTGTGGAATGGAACATAAATATCA CACAATGCAGTTTTCCTTGGCAGCAAAAATGAGCAAACAAATAACATAC ATAATAAAATGAATAATTTCACAGGCACAATGAAGAGTGAACAAAACCA GGCACAAATGAGAACACCCTGCGTGATTCTATTTATACAAAGTTCAAGA ATACGCAAAATGAACCTGTTGTAATGGAAGGCAAAACAGTGTGATCTCC CAATGAGATACCATCTCACACCAGTTAGAATGGCAATCATTAAAAAGTC AGGAAACAACAGG SEQ ID NO: 28 TTTTGCCTAGTTTTTCTGTAACCTGCATAGTTGTTTAAAGCTATAGATT TTTAAAAAAATGTGTGCATTCAAGTTTGTTTAGAGTACAAATTAGAAAA GAAGGGTGCTTTCCTTTCCCAGATAAAACCTTTGCGGATGTCTTGGGGG TTGATACTGACCTCTAGTGAAACCAGTCTAGGTCAGTGCTGTAGCTGGA AATTTAAAATCCCACTCAATTGATTGGAATCAGTGCTAAGAGTAAATTA AGCTAATAACAACTCTCTTTCAATACAGGGAAAAGAAACAGAAAATTCT GGACATCCGGAAAAATGTTAAAGATGCTATCGTGGTAAGGACTTTTTTA AATGATTGTTTACTAGAAAGGTCAAGTGCTCTTCATTCTAAAACTGTGT AGACAGAAATTACATATTGTAGATTATCATACATGGAGCCTAAATGTTT ATCCATATTTTTTTTCTTATTCCATTTTAGACAATTGTTTCAGCAATGA GTACTATAATACCTCCAGTTCCGCTGGCCAACCCTGAAAACCAATTTCG ATCAGACTACATCAAGAGCATAGCCCCTATCACTGACTTTGAATATTCC CAGGTAAGAAATGAAACAACAGACATGAGACTCTTGAGTGGCAGGAAAT TTTCCATCTCACTT In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides of these nucleic acid sequences.

In some embodiments, the methods utilize one or more of SEQ ID NO: 19-28. In additional embodiments, the methods utilize all of SEQ ID NO: 19-28 to detect an aneuploidy of chromosome 18.

The following nucleic acid sequences are less methylated in fetal DNA than maternal DNA, and can be used to detect fetal aneuploidy of chromosome 21. In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides or all nucleotides of at least one of the following nucleic acid sequences:

SEQ ID NO: 29 AACCATAAAAGGGGCAGAGATAGACTCTGTGGGTTGTCTTTGGAATATC CCAAGGGATTTGCTCCTCTCTGATCATGTAGGTCTGCGGCTCCAAGGGC AGTCCGTCACCACCCTATCTGGAGCACTCTTCTATCCTCCTCCCATCTC TGTCCTCTGGCGATGACCACAGCCCCGGGCACTGCTAGTTGTGCCCCTT GCTAAGCTCCCATATTTTGTGTTAAGGAGCAAGGATTTTCACAGGCTCA TAGAGCATTTGCTTCCTTTCTAGGGTAATTAAGACTACACTAGAAACCA TCTTGTCCGGTTCTCTTTTACAGATGTTGACATTAGGGCCCCAAGAAGA TACGTAGCCTGCTGGTGTCACTTAGGGAATTAATTCCTGAGCAGGTGTC TGGTGCCTGGGGCCCTGCTCAGACCCCATTCTCTCCTCTGGTTCTCGAT GGCCCTCACCTCCCATTTCTTTCCATTTCCCAGAGGAGTCTGGTTGAAC TTATGGCTTTTTTTGCCTTGATTAATTGACTATGAATTTATGTCCCCTA AAAAAGGATTAAGTTGCATCATTTCTTCTTAGCATGCAGTGCTCAGAGA CAACCCAGCAATT SEQ ID NO: 30 GATAAAGAAAGTAATTTTATAAGAGAGGAAATAAAATGTAATGCTTTTT CCAGCATAAGGTGAATGAGATCATCTGGGTTAGGAAGTTTTTCTATGCT GGGAAGATATGATAAAGTAATTGAACATAAGTGCCTAGAATTTTATAGG AAACTTCCAAAGTCACTTGATTTAGAAGGACAGATGAGGCTCAATATGG CTTCTTCCCTCAGAAGTGGCATAGGTTACAGCAGTAGAAACTTAATCCA GCCTCAGAAAGAGTTCCCAAAGCACTCAAAAGTTGTATGCAAAAGACTT AGAAAACCGGGCTGGAAATATTTTATACAGTAACCCTGAATGCTTTAGG ATGGTTACTTTTTAATGTATTCCATGCTTGTCTAACACCTGCCCATTCC AGGGGGTACATACGCAGGGGCCTCTCCAGGCGAGCATCTCAGTTATACT TCCATCAGGTCCTGGCAGGAACACTGGATAGGGAGGCTAGATTCACTGC ACATCGCCTCTACCATAGCTGCTCAGACCTTCATGTGCACACAAAACAC CCAGAGATCTTGTTGGAACACAAATTGCCAGGGTACAACCCAGGGGAAT TTGCATTTCTCAC SEQ ID NO: 31 AAAAATTTTAAAAAGAAAAGTATGATGATGATAAAATGAACCACTAAAA CTAAGAACAATAAGTGAAAAAAAATCACTTTTTTCTGAGTGGGAGAAAC AAAGGTATAGAGACGGTCTTGCTAAAGGAAAATTGTAAATTTAAGTAGC AATAAAGAACGTGGCATAATTTTCTCCAGCAGTATTCAGTGGCAGAGGA AAAATATATGCATGCAAGTAGTTTGGTTGATTGAATCTGTGGACAGAAA AAAATAAAAAAGAAAACCAATTGATGAATTGTGGGAAACTATTTCAAGC AATGGCCCGGGTCTTCTGGAGGTATTAGGGAATATTACAGCATGAAATG ACATATCTTAATAAAGAAGTTTAGAGAGAATAAGAAAACAGTATAGTCG AATATTGTTATAGTAACTACAATAATTAACTACAACAATTCATCATTAT ATTCAAAGACAGAGACCAAAAGATCATATTGAAACCAACCCAATAGTCT CATGGACAGTTGTTTTTGGATAAACATAGAAATTGCCCCTTTCTGGTCT TAAAACTTGAAGCCGGCCAGGCGCGGTGGCTCACGCCTGTAATCCCAGC ACTTTGGGAGGCC SEQ ID NO: 32 TGGATTTAAAAAATATATATATCACGAGCCGAAGTATGAACCACGAGAG ATTATCTCCACCCCCTGACTAAAATCTCCATTAATTAAACATGAATGCA AAAGTAGCCTCTGCCTACAATTCATGTGTGCCATAAAGATGAATAAATA ATCCTTACTGAGTGCTTTGAATCTCTGAAAAGAGAGCGAGCATACAATT GTTAGACATCTTTACACCTGCCCTCATGTTATCTAATAAGCCCATTATG GGAGTTTAATACAAAAATATATAACAAAATTGTAGAACGTAGAAATATA TAAAATCCGGGATGAGCCAGAATTTACCTTGTAACTAGAATTACTTCAT TTATAATCTATAATGCTACAGATGTATATTCTCAATAGTATCAAATAGG TTTATTTTTTCCAACCCTTGGATTTCTTCTTGCATCTTCACCATCTCTA AGCAAAGTGATTCCATAGCTAAAAGGCAGAAATGTGAATTCTTCTTCAA ACTTGTTAATACATGTTGAACAAGATGCTGATAAACCCAATCTCTAAAA ATATGAAATATCTGATATTTTGTAACTATAAAAAATCTTAAAAAGGGAA ACAAATCCAAACT SEQ ID NO: 33 ACTAGAAAGGAAAGAAACTGCCCTTCCTTTAAGGAATGTGGAATCTTTC CTTTTGAAGATCAAGATTTGGAGCCCATAATCCTGTGGATGGATGACGC CAACATTCAGCTCTGCTGCTTATTCCCCATAATTTCTCCGCTTGACCTG TGACGAATCAGCTTCTGCCTTTCCAGGGACTTAGAACCTTTCTTATGGG ACTCCTCTCACTCTGAATGATGGTGATTAATTACCAGTGTACTTTAAAA GTCTCCTCTATTTAATTACATCCTCCTGAGTATTTGGACTAATTCCTCT TAGTTTCCGGTGCAGATCGGAATGTTGCCTTGAGCAAGTCTCATGTTTC TTTCTCCCGCTTACGCAGTCAAGCACATACATAGATACGTAATAAATAT TGATTAAGGTTCTGTATTAGGCTGTGTTTTTATCAGTAAGGATTAATAG GCATAAATGAGAGACATGATCCCTACCCTGGAGCCTAAATGGCATGTGT TATAAAGACGCTTTCAGGCTGACCAGTTCTTCTAGTGCAGCTGAGAAGA CAGCCATGCCTCCTCATTAGCCCACTTTATAGGGAAGAAATGGAGACTC AAAGTATCTAAAT SEQ ID NO: 34 TTTTAGCATCATCTGGTGAGGCTAAGGATTTTCAGAATCATCAGATACT GGTTCTTTTTTGTTCGATGTTCTTCCCTCAATTTATCTCTTTCCTCTCC CGCTTCACTATAAATAACATGAAGAAACCAGGTGATACACTTAACACTT TGTTTGGAAATAGCCTTAGCTATGTGACCAACATCATCGCTTACAAGTC CTGCTCTCCATGGACAATTTCATTAAACTCTCTGGCACACATGGGAAGG ATCCTCCTTGCTCCGATTTCCTGGAACACCTGTCACATTCCTTTCTGAG TTCTCCCCGGAGGATTCACCTTTAGCATCCCTATTTCCTCTAGCAGTCT GTTCATGGTGATTTGGGCTTTCTCTGCTGTGCTACTCAAAAGTCTCTTA GCCTCTACTCGCTGCCAAGTCCCAAAGTTGTTTCCACATTTTAAGTTCA GAAGGTTTCCAACTTACAATGGTTTGGCTTAGGATTTCATAATGTTACG AAAGTGATATGGGTTCAATAGAAACTGTACTTCAAGTGCCCATACAATC ATTCTGTGCTACATTTTCAGTACAACATTCAACGAATTACATGAGATAC TCAACACTTGATT SEQ ID NO: 35 AATAAAATAGAAGGAACTTTGATATATGAATCAATATGGATAATCCTTA CTCTTATCGAAATCCTTACTCTGAGTCAAAAAATCCAGGCAAGAATGCA TACACAGTATATCCCATTTATATAAGTTTTTTAAAATGCAAAATACTTG GATGAAAGGTGGTCAGTAACTAAGTTGTTGCCTGAAGATGGGCATAGAG GGAGCCTTGGATTAAGCAAGACAGTAGGACACTTTGGGTGGTAATGAAA ATGTCGGTTTTCTTGATTATAATGATGGCTTCAAGCACAGATACAGATA TTAAAACCGGTAAATTTTTCAAATATGTGCAGTTTATTTTAATTAAATT ATTCATCAATAGAGTTTAAGACACAAACAACTGGATTCCACCAGAAAAC TAAATATATTACCTTGTTAAATTGATGCCTAAGTGAAGCATAGTGCCTC ATAGCAGAAAGGGTTAAATTTATTTCATTAATCCTCTGTTTTGAAAAAG TGATCACTAGATAAGTTTGTTCAAAAAGAGACAAAAATAATAACAAAAA CAACTAGGCTTTGACTGAAAATCCAGTGCCTTAAAAACTGTAGAGAATT TCTACACTGTTTC SEQ ID NO: 36 ACACCAGCATGGCACATGCATACATATATAACTAACCTACACATTGTGC ACATGTACCCTAAAACTTAAAGTATAATAATAATAAAAAAAAGAATGCT TGCTTACAAATTGTGTTTCTTTAGCACTTAATGTTGTTTTGTGTTTTTC AAAAAAACAGCATCCAAATATACTGGTTGACAATTTGTTTCCAGTTTTT TTCTATAAATGACAAATAGGATATTTAATTTTTGTCTAGCGTAGAGAAG AAACATTATAATTTTGACAAAAATATGGTTTCACCTTTCATATAAAATT CTAAACCCGGTAGCACACTTACCTGAAAGGTGAGAAATATGACATTGCC CCAGTAAGTGACAACATCTGTGGTGCTATCACAAGGCTAAATTCCTTTA TTGTGTCTTTTATAAGATACTGTTAAGTCTAGCAAAATACCATTTTGAG ATGCTACTTAAACGTGGCTCAGAATAAATAAAAAATTGTCAAAGAAACG TTTTAAATTAACACTTCTGATTTTAAAATATAAAGCAATCAAAGACAGT GGTTTTCCAACGTGAACACACCGGGTATCAGAGGAGTATTATTGAGGCA ATGTAAAGAGTAT SEQ ID NO: 37 AGGCAAGTAGGCGTTGGATGGCAATCCTCTCCCATGTAACCGTGCTACC CCATGGTATGTCAATAATGAAAACAAGTTATATAACAGATTAAGATTGT CTAAAATGTATTAACAAGAAGCAAAAATAGTCACATCAACTGCTCTTGT AAGCTTAGAATACTAAGGCTGTTCAGACATTCTGAAAGCAGGATAAGCC AACCTTCTAGTTTGGGTCAAGCAACATTGTCATCTCTGAAATGAAAGTG TGTGGCCAAATGGAGATGTGAACCTACCATGCTGCTCCAGAGATATTAG TTTCTGCCGGATTTGCATATCTTTACATCGAGTTCATACATGGGTGTTG GTGCCTGTACACTCATTCTATCCAGTCATGTAACTCAAGCACAGCTCAT TTTACTAATGTTTGTATGCTAATTAAAAACTCTTAGGTATAGATTCCTA TAATAATATTTAAAGTTATTATGTAGCTACTTCTGAAGTGTGAATACCT GAGTAGGGTACTTCAGATGTTCAATACTCCCTTAGAACAGTGAATATAG TAAGCACTCAAATGTTACTTACTACTTTTCTTGTACTTATCTTGGTTGT CATCTTCATTAGT SEQ ID NO: 38 GCCTCATCAAAGCATTGTAAGAACTGATAACCATCTTCTAGAAGTATCA TAGTGATATTAAGAACACACATCACAGATCATAGTAAATGGCTTTAATT TTTTAGCGAAATCTCACTACTGCAAATGCATTGTTGTCCTAGCTAATGA ATGCATAGAGTATTGCCTGCAAAATAATAATTGAGATTCTATTTTTAAG AAGCTTAGAACAGTACATGGTGCATAGCAAAGACTCTGTGTATGTGAAG CCAGATTTTAAAATATGGTAACAAGTGTCTGAAAATATGTGGCTCAATT TGTCTCCCGGTTACTTTTCCCTCTCCCCCTTTAAAATGTAGAGGAAGGA GAAGAAGAGATAAGAGGTTTGTGAGTGAAGACAAGGGCCCTTTAAGGCC TGGGAAGACTAACGCCATAGGGATCTCCCTCTGCCTTAAAAGGCACAGG AATCTTAGTGGGGAAAAAGAAGTGGTGATAAATAGCCAGTCCGTGTGCC TGGAATATCAAAGTCAGTGCGTGCCAGGGATCACACTGCGGGTCACGTG CACTCTGGGTCTCTCTCTGCAAACCTGCCCTGCCTCAGTCTGGGAATAT GCAACTGCCTAAG In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides of these nucleic acid sequences.

The following nucleic acid sequences are more methylated in fetal DNA than maternal DNA, and can be used to detect fetal aneuploidy of chromosome 13. In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides or all nucleotides of at least one of the following nucleic acid sequences:

SEQ ID NO: 39 ACCCACCTGGTCGCATCCTGCGTTCACCAGTTCCTGCAGCATTTGCCGG TTCACTTCTGCAGCTGCAGAGGTGCCCGATTCATTAGCAAAAGGCAACA AGGAATATCTGATTTCCCTCAAGGCTTTCTGATAAGGTCCGAACTTTGG GGTGGCTCTCATCTGCTGCTGCTGCCTGGTGGCATCTTTGCTCCCCAGG ACTTTGGCATCCAGGGAAGTGTCACTGTTTGGTCCTGCGGGTAGCCCCT GAACCGAAGACTTGGATGGCTGTTTTAACCCCTCACGAATCTCTTGCAG TCGCTGCCGGCTATTTCCAGAATAAGTCGTGGCAGGAAAAGTCTTTGGC CTCATTGTTAGTCCAGTTTCCTTTTACCATAAATACAATCTTCTTAAAG TGTTTTATTATTTAAAAAAAAAAACTGTCAATAGTATCAGTTTGTTGTA AACATACTTTCAAAATAATTTCCTTTTGAAAATGTTCTTTCCTTCCATT TTTGTAGTTCCTATAGAGAACCTAAAATTTTCCAAAGTCTTCATTTTGA AGATTATCACTCTCTGAAAAAGAAAATAAATGGGAGAGAAATGTTCATT TGTCATTTTCACG SEQ ID NO: 40 GGGTGCCCGTAGTCGCCGCTGACCTTCTCGTAGTGAGGGCAGAAGACGC TGTCCGCAGTCCTTAGCGGGATGATAATGTCACTGGGCTCTGAGCCGTT GTTGTTGCCGCTGCGCTTGGGTGTGGCCAGTGTGCTGAGCGACAGCGTG GTCGTGTGCTGCGGCGAGTGCTTCCTGTGTCTCCTCCGGTACTTCAGCA AGAGGACCACCAGCGTGATGATGATGACGATGAAGATGATGCATCCTGA AGCAATCCCTGCAAATAAGGCCACTTCGGAACCGAGGATGTTGTTCCCC GAATGTCCGGCGCTGTTGCCGTCTGTGCTAGAACCTGCAGACGCGGAGA CAGAAAAGGTCAGAGATAGTTACTGCTGTCCCAGTGCAGACGGACTGCT TTTATGACCCTTAAAAATGTGAAAAATAAGCCAGGCTTATTACTAACTA GAAGCTGGACTTTGCCTCGCCAATACCTCGTCTAAGAGCTCAACGCAAA AGGAAATGAGAGGTATCTCTAGGAGGGACTTCCCTACCCTCCCAAGCCA CAGGGTTTCCTTTGTATCATTATCCAGCAAGAGCACAGACTGTCGGTGA CAGCCAGCCCTTG SEQ ID NO: 41 TTTTTTACGTAATGCTCAAATAGACCTGGGAGATAAGCACTGCTATGAA TCCCCAATCCCCATGTTACAGACAAAGAAATTAGGGCCAACGAGTGGTA CAACTGGATTAAAACCTAGGCTTCTGGCCCCAGAGCCGCACACTAAACT GCTGTGCTTGAGCGCTATAAAATAACCACATTTATTTATGTATTTTCTC TAGTGATACTTATTTGCAATTTTCCATATCATGAACAAATTTCAGTGAA CTTCCTTATGCCTACCTCTTGTGTGTATGTGGACATTTCCTGGGGATAT ATACCTCCGGTGGCATACCTGTGAAATCCTTTGCTTATTTTTTGAGAGA ACAGAGCAGAGCAGATGCTAAAATTGCCTTTTTTCCTTGAGAATTTTTT TTCTCTGATAGAATACATGTTCCATGAAGGCAGGGATTTTTGTCTCCTT TGTCCACTGCTCCATTCTGAGCATCTAGAAGAATGCCAGGCACATGGGA GATGCTCAGTAAATATCTGTGAATGTATTAATGGCTCCTGAATACGACG CTCTTTTAGCCTAATTATGCGAACTCTTTTTTTTTTGTTCCCCGCCCCA CCCCCCTCCAGAC SEQ ID NO: 42 ATATAAATCTTCTTTAATAAAACAATTCTGTGGGACAGATCTGCTACCA AGGCTCAGAGAAGTTGAGTGGCCTGACCACAGTCACACAGCTGATAGGT AGCAGGATTGGGACTAGAGCCTGGGGCTCCTGCGCCCCAGGTCAGTTAC TAGGCATGAATAGAAACACCGCACTGCAACACTGAATGTTAGCCGACAT GGCAGCTAAAATGCACACATTAGCATTACCAAATGAGTGAGCCGATTGA GCAAGTGAGTTCTCCTACCACTACCTCCCCTTAGCATTGGCTTTGAAGA CGGTAACCGGGAAAACTCAGACTGGGTCGCCCCATGTTATTGCGCCAGG ACTGGAGACTCTGAGAAGCTGGTTGCAACATTTGGCGTCTTCGCTTCGG ATGCTCTATAAGCCTTTTGAGAGATGAGCCTGAGTTTGTGGCGGCAGGC TCCCTTTTGAAAGAGCCACCCAATCTGGCCTCCCCAGACATCTTCCTGG AGGAGGATTGAGCATTATTCCAAAAAAGAAGGGTGGCCTCGAGCTGGCC CATCAGGCCCTAGCAATACCCAGCTCCTCATCAGGATGGGTGCAATGTT TGTTTTGGACTTT SEQ ID NO: 43 ATATATTGCCACCTGAAGAGTTGGCTTTCAGAGCTCTTTGGAATTTGGA ATTGTAGATGGAGGGTCATGGATGTGTACCAAAAATGTTCTTAACAGCC AAGAAGTCCACAGACTAGGCATTGTGCAACAGTCAAAAGCAACTCTAGA CAGCTCCCCAGACCAGCACAGTGCTGCTTGTTCATCCTTGCTCCTAGGA AGCAGGAAGTACGTGATATCAGCTCTCTTGGAAATAACTGTCCCTTTAA GGAGTAATTGTCTTGAGTAACCCCTAAGGAAGTATTAAGTATTAAAATT CTAGGGCCGGATTCACCATCCCCTAAGGATTCTGCATTTCTCTCTGAAA ATCTTAAGTTCAGAATAACCAACCAGTTCCTTCTAAACATCAACAACCT TATGTTAAGTTCTCTGACCCTTCCCTGGTAATTCGTAAGTTTATAAAAT CTCTCCCCTTAACTTAAGCCTTAGTTTCCCAGATGCCATCACTTTGAAA ATCTGCCTCAGAAACATCAGTACCTCCTAATGGGATGTGATAGAACACC CGAAAAACTGCTGAATGGTGTGGTGCTTCCCCAGAGCCCAGGGGACAGT GTCTGGGGTCCCA SEQ ID NO: 44 GCAGATGGTATGCCAGGGACAATATACAAGACAGAATAGAGTTCATTCA AGTATTCTATGTTTTGTTATTTAGTTTTCAAATATGAACCCTGGATGGA ACCAGGCTTTGTTCCCCCAAGTTATCAGCTAAAGAGAAAGAGCTCAGCC AAGTGACAAGGTGTTGCCGCAGTGATAACTCAATTTTGTGGTTTTCAGA AATGCAGAAGAAAGAAGGTTGGAAAGAATGGGCTGGCACTCCCCGAAGA GTGGGGCTCAAAGTTCTGGTCTCAGCAGATCTTTGAGGGAGACGTAGGG TCTAGGCCGGCAAAACCAGAGAGAAGGATAGGCTTTTAGATGCTCATCC CACCCAAAACCATGAAATAATCTCCCCTGTCTCCTGATTAGTATTTGTC AGCCTCATTTACCCTTAAGATTTGTGCAAATGAAAAACGTTAAATGCAG TTCCTGGATCAGTAATTAAACATAATTATTTCAGTGGAAGAGATTTTTG TTTTCATAATCTCCTCTTTGTCTGCATAGAGCCAGCTCTTGGTTACATC TGCCACTGATAGCCTTTGCTCTGTTTACTTTAAAGAATAAGCCACTGTT TGATTTGGTTTCT SEQ ID NO: 45 TATTCGCATGTGTTTTTGTGAATCATTCTGTCGAACAAGATAGAAAAAG AAGGGCCAGTTCCTAGGTTGCACTGCGTGTCTGTGTGATGGAATGACCC CTGTAACTCCTTAGGCCTTGATGCTTCCTGTGTTGTGTGGGATACACAG AATCCACTTGCCTTCCTCCCAGGGCTGCAGAGATGAAAAACTATGACAC ACATTACAATGCTCTGTAAACTATGTTTATTCTACAAATGTGCATTATG TTATGAAAGTGGAGTAACTAATAACTCCACACTTCTGCCCTCAGAAAAC TTCCAACCGGATCATCTACCTCTTTTTGAACGTGCCCAGCAATGGAAGG TTCCTGCACGGCCTCATGTGTTGTTGCATAACCCTCAACATTAGGAAAG GGTTATTTTTATCCACTCAAACTTTCATATGTTCCAGTTTAAGTAATTT ACCCTTTCGCTGTGCTCAGAGGGGACAGGGACTGAGGACACGTGGCCAG ATCTAATTGCTTCCTCCCTTCCAGGATGAAGGATCAAAATTCTTTAACC TTTCTCAATTTCCAGTGTTTTAGGCCTATTTTTACTTGATATATTCCTT CTTCAAGGGACAG SEQ ID NO: 46 AAGAAGCTGGAAGCTGATTTAGTAACTTTATTGTAGTTTGCTTGGAAGG TAAATGTATTATTGTATCCTTCTGTTCACTTAAACTGCTGACCTAGAGT AGGTTTGAATAACACTTTGTTTAGTTTGGCCACAAAATGCCTGTGAAAG GGGAAATTCTTTGGGCAGCCAGGGCAATATCACTTCCTTATCTCCCAGT ACCCAAACACCTTTAGTTTCTCCTTCCTTCCTTCCAGTTGCTTTCAAAA AGTGGCGATGAACTGCTTGTATAGTTGCCATTTAGTATCCAAGGGGGAT TGATTCCCGGACGCCCACAGATAGCAAAATTCCTGGGTGCTCAAGTCCC TGATATAGAATGACATAGTATTTGCATAGATCTTATACACATCCTCCTG TATACTTTAAATTATCTCTAGATTACTTATAATACCTAATGCAGTATAA GTGCTTTGTGAATAGTTGTTATAATGTATTTTTAATTTGTATTACTTCT CATTTGTTGTATTGTCATTTTTTTCCCCTGAATATTTCCTACCCATGGT TGGTCGAATCCTTGAATACAGAACCCAGGGATACAGAAGGCTGACTATG TGACATTTCTTCC SEQ ID NO: 47 AGAGCTTACCAGTGTTATTTTCCTTATTACTTCTGAGTCTGGCATGCTA GTTTGGTTAGTGATATATTATTATTTAGGCCAAAGTCAGATATTTTATA ACTACAGAAGCCAGTTAGTTACCTTCCCTTTGTTTCACAACCGAATACT ATACTATGCACCTATGGTCCCATCTAAAAGATATTACTGGTCATAAGAA TGTGGCTGTCTCCGAAAAAATTGTCACTACTAGAAAAACAACTGAAAGA ACATAGTGTAATTAGAACAATATGGCCAAACACGTTTCGTTAATACTGT GTGTTTCCGGAGGAAAGGGAAATTAGCAAATATTTTCCTCCTTTTCAAC ATGGCTATGTTCCTAAGCAAGATAGCCTTATCCTGCTGAGGAGACAGAG GATGTGGCATAAGACATACAGAAATTGACAAACATATTAACCTTGTATA ACTAGGACTTTTTTACAAGGTATATTTCCCTTGTAAAACTAGGACTTTA ATTTTGAGAATAGGATGGGACAGAGTCAAGTGAAAGAAGCCTTAGGTAT CACATGGCACCAAGGAAAAACATCAAAGATTTCTGTCTGCTGCCTTTTC CACATAGTCCTTT SEQ ID NO: 48 CAGTAAAGAGACCAGCCACAGATAAGTAATTGGCAACCAGCAAGGTAAT AAATCTAGTGTGGGGGACTGGCTGACGTTTGGTCAATGTCTCCTTCCGA AGCTCCACCCAAATTTCTCCTTTTTGCTTCTCAGTCACAGTATTTCCCT CCTGTTAAATAGCATTAGTCTGGGGAATAAATGCTCTTCCCTGTCTACT ACACTGTGGGAAACGTCAGCCACAGCCTCCAGTTTGTTAGGTCAAAAAC CTTGAAGTCATCCTCTCTTCCTGTCGTAGCCACGTTGATCCATTCACCA GAAAATCCGGCTGGGCCTACCCAAATATGTAGAGAGCCCAGCACGTTTT TACCTCTTCCGTCGCCATTGCCTTGGACCAATGCCTCTCACCTGGACTA TAGGAAGGTCCTCCAGATGGCAGCCCTGACTCTTTCCTGCCCCTCTCCA GCCGCACTCAGCCTCACAGTATCGATGATGATTTTCTTCACAGTCAAGG AACAGAGCTCCTGGGCTGGAACCTCACACCCAGGAATCAGGGTCTGAGC TGAGGTCCTGACAGTCACCTACAGGATTCTGAGCCTTACCCCATTGCAC TAACCTTTCGAAA In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides of these nucleic acid sequences.

The following nucleic acid sequences are more methylated in fetal DNA than maternal DNA, and can be used to detect fetal aneuploidy of chromosome 18:

SEQ ID NO: 49 TGTATAGATGCAGAGTTTTACTACTGAAAGGAGGAATACTACTGTTGAT TTGTTTTTGTTTCTCGGTTGTTGTGCGTGTGTTTTGTTGTTGTTGTTGT TGTTTTACCATCTTGGTCCTAAGTAGCTCGTTTGCCGGCCCAGCCTTAA TGGCCAGTTGGCTCCAAGTCAGAAGACATGATCTCCTCCCCCATTCTCC ATGCCATTGTTTAAAGCCCCTCCTGAGGAATGGGCTGCCTTGGTGTTTT GTCAGTTCAAACCACATCCTGCCTGTTTCCACTTTCCATAAGACAACTC GCAACACCGGTGGTTTTCAGATGTGGCCGGCTTCTTGGTGAAGCGATAG CAGAGGCCTTGTTCACAGAAGTGAAAATAATTCACCCAGTGGTTAGCAC ATCAGGTGTGGGCATTGAGTGTACCCCGCTCCCTGCTTGATCCCAATCC CTGGTTGGGTTTGGGAGTGGACGGCTGCCCAACCTCCTGGCACTGTCTT GACCCACAGCCTTCTCTGGGATGAGGACTAAGCCAGAAGCAGTAAGGAC AGAGGTGTCTCAGGCTGTCCAGGCCTGGCCTGAATCCCATGACAGCAAG GGTGTGGCCTGCA SEQ ID NO: 50 GCTGAGGGATTTGGTCATATCATTAGCCCAGACATAGCCTGACAAGACC AGCCCTTGTGTAATGAGATTGGTTTGAGGTAGGAACTGTACTTGCTTTC TATGATGGGCAAGAGGAGACCCCAGGCTCTGGATGGGAAGCTGAAGGCT GACCAAGGGTGGATGAGGCAGAGGGCCTGCGAAGGGGACTCCACAGAGG CCACACGCAGGACAAGAGCAGCACTCTACTCCAGGCTTCATCCATCGTA TGGAGGTCTGTGGTCATTTCACCCATTCATCTTGCTCCTCTGGAGAACC CAAACCCCGGAAACCACAAAGGGAATCGACTGCTGCTTCACAGGAAGGG TTTCATTCATGATCACATTTCTTTACTGAAAAAGATGGGTATATTGAAG CGTTGACTGCCTCCTCAAGAAGAAACAGGAAGTGATCATTACCAAACAG AGGCTCCCTTTAAATTTAAAATATGTAGCCAAGAAAGAGGCTAACACTA CCTAAGAAAGACCCCAATTAAATGTTTAAGCTAAAAAAAGCAGAGGGTT GGGGATAGGGCATGTTTTTGTTTTGTCTTCCAATTTCAGTGTTTTTAAA GGCTGAGCACCAA SEQ ID NO: 51 GATTTTTGCAGAGTTATTTTTAAGCAGTACAAAGTAGAAACACACTTCT TGAAACAAAAATGCTTTGTCATTTCTTAATCTCTACCTTTAAAAATAGC AAGCAGCTATTTCACTCTGAGGAGCGCTTACACAGCCATCACTGCCCGC AACCCTGGGACCTGAGGGGGAGATGGGTGAGTCTGGAGAAAAGGCTGTT TCCTAAGAGTCTCGTTGCTAGTCCTGCTCGGTCACATGACCTCACCTGT GGTCCCGAGCGATAGTGGGCAGCACGCAGTTTTATTACATGAGGCAGTA TGTCTCCCGGTTCACGCTTATTATAGCAATAATTCCAGAGCTTCTCACT CTTGGTTAAAACAGAACAGAAACACAAATGCAATACCAAGCACAAAACC ACGAACATCTTTGAGTAACTGGGCTCTTCCTCCTACACAAAACGTCCTG ACGGGTCCCTCAGAGTGAATCTATGGTCACGACCCGGACCCCGGAGGCC TGTGCATTGAGTATGCGCTAAGGTTTTTAATACAACTGGCTTCTTTCCA TTGTCTCCCAAATATCCCACCCCAGGTAGTTGGGTACTGAACACAAACT GGTCATTTTGATA SEQ ID NO: 52 CATGGTGAGACCCCATCTCTACTAAAAATACAAAAAATTAGCCAGGCAT GGTGGCGGGCACCTGTAGTCCCAGCTACTTGGGAGGCTGAGGCAGGAGA ATGGCGTGAACCCGGGAGGTGGAGCTTGCAGTGAGCCAAGATCACGCCA CTGCACTCCAGCCTGGGCAACGGAGTGAGACTCTGTCTCAAAAAAAAAA AAAAGGGGAAGTCACCAAGAAAGGGATAGAGGTCAGTGACATGGTCATC ACACAACTCGGTCATTTAATATGGCAAAACACAATACCAAGAACTGTGC ATTAGCCCGGAAGGCAAGAGGGTTGGTTCTGCCCCAGCTCTGCTGCTAA TGAGCCCCTACCAGGTTGAGCAAGTCTTTCCCCACTCTCCACCTCCATT TCTTAATCAGTTTCATGACAGGGAAGGATTTGAAAGTCCTTTCCACCTC AGAAGTGTTGATTATTCTCTCTCTCCTATAATCTGATGAAATCAGCATG ACAACAAGTAATTTAAGTAAAGGACAGAAGGGTTACCCAAGAAGAGGCA GGAAAATGTTAACGTTCTATAAAGTTTTATTCTTGAGTCATAGGAAAAT GCTCTCCAGACGT SEQ ID NO: 53 CTTGTGTTACAGATGGAAGATAAGATTGGAGAGGAGGAAGAGTTAGTTT TGAGTCTCTGACAACAGGGCTGCCACTGCCAGATTGCATCAAACCGTTT TAGGTTTTGTCTTCTGGGAAGCACCATTGCATCATAGTCAAACACGAGG GCCAGGAAGCCCAAGAAGTGTGGGTTTCAATTCCATCTCCACTTATCAG CCACACTTTTGTGCCTCAGTTTTCTTATACACAAGATAAGGCTGGTAAT CTGGCCAAACTTTCAGGATAAGAATTATAGACATTTAAGAAACCCAGGA AACTGTCCGGCACATAGGAAGCATTGATATTACTGAGTGATAGCACTGA GCCAGTAAAACCTAGACAGAAGTTGGAAGATAGGGCACAGTGTTCTTGT ATCTTCTGAGCAGATGGGTAAAGAAATTGGATAAGAATTCAACGTGGTG GCTGTTGAAAGTCATCACTGGGTCTTCTTGGTCCAGCCATTCCCTTTGG TCTCTGTCTTTGGCCTGGACCACCATCTTACCTCCATCATTCTTGAAGG ACACACCTGAAGCCTCACCATTGCAGCAGGCTTATCATCAGGAATTAAT AAGGTGCAGGGAA SEQ ID NO: 54 AAAAAACTGCTATAATTCAACCAGTTCTGACACAAATGGTGGGTTTCAG AGAACGGAGTAGAGATGAGAGAAGTGGCTTTTAGCAAGAAATTACGCAG GTGACTTTCAAATAAATCATCTACATAGAAGGCACGTTTTGCCTCTAAT GTGCAAATAATTTAGCATCTGAAATGGCATGTAAAGATCTCATTTTAGA TTCAATTCCACTCTAATTCATCAAAATGGGAAGTAAGGCATTGTGGCAT AACAATTGGGATCAGAAGACCTGTGGTTACATCTCAGTTCAGCCCACAG AACTAACCGGGACTGAGGCCATTGGTCTTAGACCTCTCATCTGTGGGAT GGGGTTACTAAGACTGATTTCCTATGTTTCTTTGCAAAACTTGAAATAA TTGTGTGAAGAGTACTTTGCAAAGAGATAAGTGCTACAGAACTATAAAG TACTAAATAAAAGCTAATATATTAGGCATCTAATAGGTATTAATAGCAG CAAGGTCTGACCACAAGCAAACACCTATTTTAGGCACTGACTTCTGCCA AAAATCCGGAGCTAGATGGAGGAAGGAAAGGCTCATAAATCAGTCTCCT TAAGAGGCCTCCT SEQ ID NO: 55 CAGCTGGGGCAGGAAAACAACGGTGCTGCCTATTTCTTGGACCCCAACT GTTTCTAATTTGAGTCACTCTTCAGCACTCCGTTAAACCCCAGTCCCCA TCCTCAGTTCCCAGGTGGGTTTGCATAAGGGGTAGTAGACCTGCCAGGA GATGCAGTGAGAAGCACTGAGCACTGAGGCAGGAGGAGCACAGACAGCA CAGAGAATCCTCTAAAGTGAAGTTTCTCTCTTTCTCACTGTTGTTGGGG ACTCACCCTGCACCACAAAGAAGACTAGATAAAGAAAACCACTAACCAG TAACATCCGGCTCAGTAGGCTGAGCACAAAAGCAAGGTTTTGCTTTGGC CCTAGACCTAGAAGCCTGCTGAGTGAGCGCCTTGGCCCTAGAAAAGAGG AGCAGGGGGTTGTCCGGAGCCCCTCCGACCACGCTGCTCTCAGTCAGGC ACCACAGACACAGGCAGAGCTGGCTAGAGGTCAGAGGCATGGCCCCAGT GAGAAGCAGCAGCTGTGCCCTGTGAGCAGGTAGGATGGGGTTAAGGGCT GGCCTGGAATGGGGGCAGAAGGTGGAAGTTGGGAAATGGTGATGACAGC AGTTATTGCAAGG SEQ ID NO: 56 TGGCTTATTTTTAACTCACTTAATATTTTTCTCTTGAGAAATGTTAAGC TAATTTTTTTTTTTTTAAAGGGAAGCAAAAAGGCCTGTACTACTGTCAA GGCAGACTGAACTTATTTTATTGACTGTGTTTTTCGTTATGGAGGACTG TGTGTGACAGTACTTCTTTTACTTACAAAGAATTCTTTGTCACAAAAGC CTCATTCATCCACTGACATTTTGGGGTTCCTTTTTCTGTAAACAATCAA TCTAAAAAGGAAGTGCCTAATCGGGTGTTTATGTTACAGGTGTAGCCTG GCTGGGCCGGGGGTAGTTGGCTTCCTTCTGTTTTTCCTATGCTCTCGGG AACATTTGACCTTTAGTTCCTTTCTAAATGCCTCAGTTCATTAGAAATG TTTTGTGCTCATTCAATAAGTCATTTATTTGAGGTCAGATTTATATTTT GAAAAGGTCATTTTGGCAAGTTATTTGGTCTTCCCAAAGTCCAGAGTGT CCAGTATAAAATAGGGATATCATTCCTATCTGTTTCCTATAATTGTTGT GAGGATGAATGTGTTAATGTAAGTGAAAATGCTTGGTAAACAAGAAGGA GATATATGTATTA SEQ ID NO: 57 GATGTAAAAATGGGATCCTTGATTTTTAGTATCTGTTTTGCCGTCCAGC TGTGCTTGCTTTTTAGGCCCTAAAAACTGTATGTTTTCTTGGCCCTGTT ACTTAAAAGGCTCTACCCTGAAGCCAGTAATCCAATTAACTTACTTCTT TAAGGAAATGTTTATATGTAAGGGTGTCTGCTTTTCCTCTCCATCTCAC CTGAACTTTCACTCACGCCATTTTTCCTTTGTTTGCATAAAATATAAAT TCTATATCTTGTTTCACTTAAGTTTGTCTCTTCAGAAATGCAGATTTAG AGTTGCCCGGCTAGGAACTGTTTATGGCAGGAAGCAGGTATTCAAGAGA CTGTTGGTCTAAAATGGGGAAGAGAAGCTTAAAACTAGCAATTGAAAAA TCTTTTGTCTGTCTGTGTAGGTTGTGTGTGTGATGTTTCCCTACTGAAA TATATAAAGGTGCTCTAATTAATTGGCTTTAAAAAAATAAGCACTTACA TAAAATATTTTGTCAGAAAAATAGAAACTAAAATGCCTTTTAGCTCAAG TGACTTTAATAATCTTTAGTAAATAAAAATAGTTTTACAATTATTGACA AAAGTCTTTAAAA SEQ ID NO: 58 GACATAGTGATAGGTTAGACTGTCTATTGTGAGATTCACAAAGGGGTTT GGAACAGAAATCTAGACCAAGACCTTTTACACAAGAGATTCTTTGTGGA ATACTTGCTGGAATATTCCCAGAGTATTTTGGGATACCCCAGACTCATA CAAGGTTGTATAACCTCTAACTAACAAGATTCTAAGCAAAGGATGAGAC GTGATCATGCTCAGGTAACGAAAACTTAGGGTCAATTCATGTTCTAATT AGTTCTCTTGATCTAACAGTTACGGCTTATAAATCATTCCATGTCGGAA GCCCCACCGGAAATAGTTGAGGTTCAATTCAGTTACAGCTCAATGAAGT CTGAAAACAAGTGTCCAACATTTTCTGGTTCATGGTTTAAAATAGGTTT CAAATAAACAATGAGGAAGCCAGTTTCCTGTTTGGGTTGGGTCCATTGG ATCCTAGCCCATCAAAGCTTTGAATTATATTACAATGACAGGCAAGGAC TAGAGGGGGAAGAACTGAAACGCAGAGAAAAGTTGGCACAGTGCCAGGA AACCTGGCTAAAATTAAGTCCCTCAGTCCAAAGAAAACAATGGCAGCTA GGACATGAGTCAA In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides of these nucleic acid sequences.

The following nucleic acid sequences are more methylated in fetal DNA than maternal DNA, and can be used to detect fetal aneuploidy of chromosome 21. In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides or all nucleotides of at least one of the following nucleic acid sequences:

SEO ID NO: 59 AGACACACTTAAGCTGAGCTTAGAGCAAAGCATGTCCCTCAAGGTGACC TTGCCGCATGGCCTGAACCTAGAATTCCCCTGACCAGGGTGGACAGCCA TCACCATGGGCCTTTCTGCCTGGCCTAGTATGGCTCTCCTTCGAACTCA CCTAGACCCTTGCATCAAAGGACTCGGGGACTCTGCTGCAGTCATCCTA GCACGGTCGAGAGGAGTAGGAAGGTGCCCAGCGGCTCAGCCTTTAAGGA GGTCTATTGGTCACCATTGCTTCTGCCTTCTTGAGAACCATCACCCTCG GAGGATCCGGTAGTGTATCCCAGTCAAGTGTCAAATGCGTTGTTCCCTG GAGAGGAAGGCTTATTTCCAGAAAGTACTCTGACGTTTTGTAATTTGTG ATTTCTATCACTGGCTCAGTGGCCTACCCACTGCTCAGCTCATGTGGCA TGACCAGGCTGGGGCGTCGGGTCATCTTGTTCTCTGGGTGTGTGGCAAC ACTGGTTTATGGCGTAATTTCCTTCCTGAGAAGAAATTCAGTAATTTCT AATATTCAGGGCTTTAGGTAGAGGCCTGAAAATCACTCTCCATGCCTCT TTCAGTATTTTAT SEQ ID NO: 60 TAGTAAGCAAACAACTGAGGGACCAAAAAAAAAAAACAGGTTTTAAAGT GACAAGGTTCAAATCTAGGGTAACAAATGGCAAGATGGGAGTACTCACA TGATCAAAGAAATGTACCACTGCAAGCTTTTTGCTGCGCCTGGTAAAGA TGCGCTGCACTTTAGCAATTTTGCCAAAATGGTTCTCCAGAATGGTCCT GTCGTTGAGGTAGTCAGGGATGTTCTTGCACTGGATGGCTGTGACTTCA GAGGGAGACAAGCCCCCAAGACTGTCTGTGCTCTCGCTTCTGTTACTCT GACGCGCCGGAGTTCCTCTTAGAGAATCTAGGGGTTCAGAGAATGGACA CTTAAACCATCAGATGTTTCCAACAACAGGAGGCACCAACTGTGTCGAA GCAGAGGAAATTTTCAGATGTAAGACCTGCTCCGATGACATGTTAGAAT CCCTAATGTTTATGGGAGATTTATCTGAAAAATCAAGCTAACACCCAGA GAAACGTATTGAAAACCTGCCTGCAGGATTTACTCTATGTGCTACATTT TCAGAGCTCACCTTCTTTCTTCTCTCTACTTTCAGTTTCTTCCTCTTTA TTCACACCTGGAA SEQ ID NO: 61 AGAAGGCGCTTATACATCACGGCCGTTGCTCATGCTTGGGTTAAAAAAG GTCTCCCTTACAGCCAGGGCTCAGGATCCCTAGGCAGCTGGGGGTTGGC CCCCGGGGCTCAGAGGTTAACCCTCTTCCTCTCACAGATGGGCCTAGCG GTGGGAGCGTTTGTGGCAAGCTGCAGAAATGAGATGCGAGAGAGAGAGC CCGTCCTTCAGAGTCCACGACAGCACAAAGGAAATGGCCGTGGGTGTTT CGGGTTTAGCTGTCTTTGTTCCTACACGTTTATGTTACCTGCAAGTGGA AATTCACCGGCACATCCTCTCAAAAATTATATTTTGTGTAAAAATATTT AAGCACTAAATGAACCTCTGAGAGTCGGGATAGCGCTTCCTTGGAGGGG GGAAAGTTTGGGGAGGAGGGCACGGGGGCTCCCTTCCTTGGAGGGGAGA AAGTTTGGGGAGGAGGGCATGGGGGCTCCCTGAGGGCCAGTCATGCTGT TCTTGGTGTGGGTGGCAGTGACACAGGCGTTTGCTTAGGGACAACTGTG CTGTTCTGACTTAAGTGCCAGCCTGTGGAAGCGCCCACTGACTCAAGAT TAGATAATCTCCC SEQ ID NO: 62 GGATACAACTAGCCTAGAAAAAAGTCTTCAAAGTTCTTCTAAGCATTAG TTCTCCAAGTGCTCCAATGAAGGCTAACAACCCAATCCAAAGTGAAGGC TTCTTTTACTTCTTATAAACAATTTCATAAATTTTTGTCTTAGTATATA ATAAAAGGATAATAAGCTACAAGATAAATGATTAAAGATTAACCAAATT TGGTATTCATGAACTAAAACGAACACTTTTCTAGATTTTAAGGTGGGCT CTACTTCAGCTCATTACTAAGATGACTAAGCACCATGCAAAATTTGGCA ATGCTGCCGGGTCTCAAGCATATATATGAAAAAGTCTGCAGCCACAACT ACCCTAACAGAGATTTCAGAAAGGATGCTCTAAGTCTATCATGAGTGTA ACCTTAAATAGATTACTTTTATACTGTTTTATTCTTCCTTTTAAACTGT AAACTATATTAGTTTAATATCATCAATTTATAGTTAAGTTAGTTATTTG GTTAACTCTACAGTGTAGAGCTATGCATATTTGTTGTCTGCACCTTTAA CTTTCCAGTAACTAAATGTTACGCGTTCGGTGTTGGAGAAATGAGACAT CTACTCAGTAACT SEQ ID NO: 63 AAACGGACCACAACTTTCTTCAAACTTCTTCAAAGTTTGCATGTCTGGG AGACCAATAAAGGGCAGGGCATACGAAGTAAGTCTGTTTAGGTCAGTTG TTTATGGGTAGGTGCGACTTCATTCCTGTTCGCCCTACTTGCAGACATG GTAACTTAGAACAGTTCTTCAGAAGCTGTTCGATGGCAACGTGGCGGAC ATGGAGCTGTGAGGCCAAAGAATCTTTTTCTTGCACTTGGTGAGTTAAC TCTTCAAAAACTTCTGTAAAAGATTTAAAAACTTTCATTTTTAGTATGC AGAAAGCCGGTGCTATGATTTATATTTCAAGAACTCTAACTGAAATCTA TGCATTGGGCAAAGTGTCACAATGAAACTGATTTGATACCAAGGAAACA GTTCTGTTCTCTACAAAGCATATCAGTTCTGATCATCCTAGGCATCTGT ATACTTTACATAGCCAAATGGAATTTGGCTCTTCTCCATCAAGTGACTA CAGAGATACACAGCAAAAATGGTGGTTGCTACTGTAGCTGAGCTACTTT TCTCAATTAGAATCTATAAACAGATTCAATTAGTACATAATGTGATTTA TGGACAAGAAGTG SEQ ID NO: 64 CTGCATTTTGTGTGAGTATAGCTGGATCCGCTTTGATTCTACAAATTAG GTGCCCTTCTGTTTCTTAGTAATGTCATATTCTCTGACCACTGTAGCCA CTTAAGATAGTCTCAAATATGAATAATTTTCAGTGGCCATAGTGGAGAA GATGCTGACCCAGGAGGCTTATTCTCACCTCCACCTCTTAGACTCACAT GTATGATTTTTTTTTCTCCCTACCAAAGTGGCTAGTTTTGACAGCCTTT AGGTTGCAGAACTGTTTATATTCGAAAGAAGACCTTACCTTCATAGAGC ATTTTCCCGGGCAGTTGTTCTGCTTTGTGTTTTTAATATCTACTCTTAT TCGGAGTCCCAAAATGAGTTAGCTTGGGTAGCTCTCACAATGAAAACTG ATTTCTTCGCATAAAACTTTATTCTACCTTTTTGAAAACCAGCTGGAAA TGATGAATGGTGGCTTCAACAGTAATGGTTCACGAAGAACTGATCGTGT CCCCATCAATGAGGTCTTACCCATGGCAGGGCAATGGCGGTCTACTGTA ATTCTGTGTTGGTTGTAGTAAGTTGGGGGAATATCAGGCCAAGAATCAA CAGAGCTACGTGG SEQ ID NO: 65 TAACCCTATCTAGTACAAGTTCAATTATGTTAAGCTAAAAACTTTGCTG TAAAATATTAAATGCCAAGCTCAAAAAATCATAAGGGACATCCTCTCAG CCCTAAGTTCTATTCACCCTGATACTCAATACATTTGAAAGTAAAACCT CACTTTCGAAGTAACGCTGATACTGAAGCAAGGAGATGTTGAATGACTC ACCCATTTCATAGCTTTTCCGTGGCAAAGCCTCACTAAAACCTATCTAA TCCCTAGCTCCAATTCTTTAATCTCCATGGTGCTTCTGATTAATAGTTA AACCACCCGGAAGTATGTTAAGGATACTAACATTTTCACCCCGAAGTAT TATCCTTCGCCATCCTCTAGAATATGCTATGCAAAGAGGCCTAAAACAA AATAAACTGCGACTTCAGCAGCTGAGAAGTAATGATTCCTTTCCCCTCC CACACATCAAAACTTCCTATCCTATCCCCTCACTACTTTTTTTCCTTTT TAAAAGTAACAATGGTCATTGAGAACTACTAAATCCTGCAACACTCACA AGGTAGTATGTACAACCACAGTTTTCCCCCGCGATACTTCACTGAAGTA TTCAATACAGCCA SEQ ID NO: 3 TGATAACACTGGGGAGAGTTAACTTTTTCACCTCTGTTTGTTGATATGC CCCTTTGTGCTCCGTATTCACAAAGGGGCACCTCAACAAGCCCATCATT TGTTAATGAATGCCTTTACTTTCATCGCCAGCAAGACATTTTCATAAAC CCACCATCTACTTTGCAGTTCTCAAGAGTTGCTTCTCTTAAACTGGTGA GGACGCGGCTAAGCCCTGGAAATGAGTCCAGATTCTCACGGTGGCCCAT AAACACTGCTGTTTCCTCCCACCTAGGAAACCCGCAGACCTGCAGAACC TGGCTCCCGGAACAAACCCTCCTTTCATGACTTTTGATGGTGAAGTCAA GACGGATGTGAATAAGATCGAGGAGTTCTTAGAGGAGAAATTAGCTCCC CCGAGGTAGGCCTCAGAAAACCAGTGTTCATAACTTGATTGTCACTTTC CCCCACTAGTAGTCAGTTCTAAAGCTCTGGGCAGTGTGTGTGTGTGTGG TTTTCTGCAGCCCACGGTGCTCACTTCCTTAATCATAACCCTGGTGTAA CCAGATTAGAGTTCGGGGACCTGGGTTTCATTGTGCTGCACCTGCAGCT TGGCAATCACAGT SEQ ID NO: 67 GCAAACCACCCACTTCTGCCCTCTGCCCTTCTTCCCTTTTCTCGACACC CTGCGGCCCCCCAGTTTCAGCAGAGTTTATTTGGGGTGAAAAACAAGAG ATGCTCAGCGCCTGTGGGATGTGTGGGCTGACTCGTACATTAGGATGTG TGTCAATCTGAAATAACCTGGCCGTTATATGGATGCCTTGGGGCTTGGG GGGTTTCTGGCAGTCTGTCGAGCCCGAGGTGAATGTCCCCAAGGCTGCT GGTGAATCAGATCCCTGGCGTTCTCCGTTGGCAGTTCAGCCCAACAGTT TCTCTGCCGGCCGTGCCTCTGCAGGTCCCTCCTCTGATCTGATTGGATT AATATTTGAATCAATAGACTGAGTCAAGCAGAATGTGGGTGGGCCTCAT GCAATCAGCTGAAGCCCTGAAAAGAGCAAAAGGGCTGCCCCTTCCCCCG AGGAGGAGAGAACCCCTCCTGCCGGACGGCCTCCGAACTGGAACATCAG CTTTTTGCTGCCTTTGGACTTGAACTGAAACATTACCTCTCCCTGGGTC TTGAGTCTGCCTACGTTGGCACGGGAACTACACGTTGGCTCTCTTGGGC CCCAGCTTGCTGA SEQ ID NO: 68 CCTTTGTTCTTGTTGGCATCTGTGTAAGAGAATCCAGGGCCTGAACCAT TGTCCACTCAAACAGACCATACACACCTGGTCCAGTTTTGTGCATGCCT CCCTTTTCCACAGTGTGCCACTTGCTATAGTTCTGAACAAAAACTCCCT TGCCCTTCGGAGCTTTATTTATTTTTAATTTGCTCTGTCATTGCATTGC ATGCAATAGAAGCTTCCTGGTGGAAGCTCAATGTTCTGCTCAGTCCCAG ACACGTTTTCAGCCACTGTATCATTGCCTTAGGTTGTGGTTTCCCCAAA GCAGCACCGGAGGTAAGGGCTTGTGTGCAGGAGTTCACTTGGGAGGTGG CTCTAGGAAATAGAAGCGAGTTTCCAGGAAGTGTGGGATGAATACGGGG ATGGGGTGGGGGGCGGGGAGGAATCCAATATGAATATATAATCTCATAT TGAGTATAAAAATCCAATATGAGTATGTTTTCCAGACTGCTGCTAAGGA GAATGGTGAATTATTCTACTGCGACCTTTTGAGGGTCCACACAATGCCT CCCAAAACTATCTACCAGAGGGTGGATAGGAAGCATTGATCCATGGCTT ATATTCCCCATTG

In some embodiments, the methods disclosed herein utilize at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides of these nucleic acid sequences.

All nucleic acid sequences from U.S. Provisional Application No. 61/361,824 are incorporated by reference herein in their entirety.

In some embodiments, the methods disclosed herein use a portion, or the entirety, of one, more than one, such as 2, 3, 4, 5, 6, 7, 8, 9, 10 or all of SEQ ID NOs: 1-7, 29-38 and 59-68, and 83 to detect aneuploidy of chromosome 21. In additional embodiments, the methods disclosed herein use a portion, or the entirety, of one, more than one, such as 2, 3, 4, 5, 6, 7, 8, 9, 10 or all of SEQ ID NOs: 8, 19-28 and 49-58 to detect aneuploidy of chromosome 18. In some embodiments, the methods disclosed herein use a portion, or the entirety, of one, more than one, such as 2, 3, 4, 5, 6, 7, 8, 9, 10 or all of SEQ ID NOs: 9-18 and 39-48 to detect aneuploidy of chromosome 13.

In some embodiments, multiple selected loci are analyzed in parallel. Without being bound by theory, this can be to reduce the negative effect of inter-individual variation in absolute DNA methylation level at any given locus. The resulting test can provide highly accurate determination of the copy number of a particular chromosome or region of that chromosome relative to the other chromosomes tested. Biomarkers specific to chromosomes 13, 18 and 21, enable the test to define a normal range of inter-chromosomal count ratios between chromosomes 13, 18 and 21 for euploid fetuses and thereby determine deviation from this normal variation in when a fetus is tested that has aneuploidy on either chromosome 13, 18 or 21. A copy number ratio of 1:2 or 2:1 indicates the fetus has aneuploidy.

In some embodiments, fetal DNA is isolated from a maternal sample, such as, but not limited to, blood, serum or plasma. In addition to the acellular portion of the whole blood, DNA can also be recovered from the cellular fraction, enriched in the buffy coat portion, which can be obtained following centrifugation of a whole blood sample from the woman and removal of the plasma. There are numerous known methods for extracting DNA from a biological sample including blood. The general methods of DNA preparation (e.g., described by Sambrook and Russell, Molecular Cloning: A Laboratory Manual 3d ed., 2001) can be followed; various commercially available reagents or kits, such as the QIAamp DNA Mini Kit or QIAamp DNA Blood Mini Kit (Qiagen, Hilden, Germany), GENOMICPREP™. Blood DNA Isolation Kit (Promega, Madison, Wis.), and GFX™. Genomic Blood DNA Purification Kit (Amersham, Piscataway, N.J.), may also be used to obtain DNA from a blood sample from a pregnant woman. Combinations of more than one of these methods may also be used. The methods disclosed herein use the methylation status of fetal DNA to isolate fetal DNA from maternal DNA. Once the fetal DNA is isolated, the copy number of an allele on a chromosome of interest can be determined.

In some examples, a sample, such as a blood, serum or plasma sample, is obtained from a pregnant woman at a suitable gestational age, such as 10 to 14 weeks, or 11 to 13 weeks for a human subject.

The gestational age may vary depending on the disorder to be assessed and the mammalian species. In some embodiments, a sample from the first or second trimester of pregnancy is utilized. Collection of blood from a pregnant female is performed in accordance with the standard protocol hospitals or clinics generally follow. For a pregnant woman, an appropriate amount of peripheral blood, such as between 5-50 ml, can be collected and may be stored according to standard procedures.

The analysis of fetal DNA found in maternal blood can performed using, for example, whole blood, serum, or plasma. The methods for preparing serum or plasma from maternal blood are well known among those of skill in the art. For example, a pregnant woman's blood can be placed in a tube containing EDTA or a specialized commercial product such as VACUTAINER® SST (Becton Dickinson, Franklin Lakes, N.J.) to prevent blood clotting, and plasma can then be obtained from whole blood through centrifugation.

Serum can be obtained with or without centrifugation following blood clotting. If centrifugation is used then it is typically, though not exclusively, conducted at an appropriate speed, such as 1,500-3,000 time gravity. Plasma or serum may be subjected to additional centrifugation steps or purification steps before being transferred to a fresh tube for DNA extraction.

There are numerous known methods for extracting DNA from a biological sample. General methods of DNA preparation (see, for example, Sambrook and Russell, Molecular Cloning: A Laboratory Manual 3d ed., 2001) can be followed; various commercially available reagents or kits, such as QIAAMP™ DNA Mini Kit or QIAAMP™ DNA Blood Mini Kit (Qiagen, Hilden, Germany), GenomicPrep™ Blood DNA Isolation Kit (Promega, Madison, Wis.), and GFX™ Genomic Blood DNA Purification Kit (Amersham, Piscataway, N.J.), can also be used to obtain DNA from a sample, such as a blood, serum or plasma sample, from a pregnant woman. Combinations of more than one of these methods may also be used.

The DNA present in a sample from a pregnant woman, whether or not extracted from the sample, is then treated with an agent capable of preferentially modifying DNA depending on whether the DNA sequence is methylated. For instance, this agent can be an enzyme that digests DNA in a methylation sensitive manner, for example only unmethylated DNA will be digested while methylated DNA remains unchanged. Another method includes the utilization of an agent that selectively converts a polynucleotide sequence depending on the methylation status. Typically, such an agent reacts with the unmethylated C residue(s) in a DNA molecule and converts each unmethylated C residue to a uracil (U) residue, whereas the methylated C residues remain unchanged. This C to U conversion allows detection and comparison of methylation status based on changes in the primary sequence of the nucleic acid. An exemplary reagent suitable for this purpose is bisulfite, such as sodium bisulfite. Methods for using bisulfite for chemical modification of DNA are well known in the art (see, e.g., Herman et al., Proc. Natl. Acad. Sci. USA 93:9821-9826, 1996). These methods can be used to selectively purify fetal DNA from maternal DNA.

Additional methods for identifying and/or purifying regions of differential methylation and for determining the allelic ratio, are described in, for example, U.S. Pat. No. 5,871,917; U.S. Pat. No. 5,436,142; and U.S. Patent Application No. US20020155451A1, U.S. Patent Application No. US20030022215A1, U.S. Patent Application No. US20030099997, and U.S. Patent Application No. 2009/0019278, the contents of which are herein incorporated by reference in their entirety.

In one embodiment, the method utilizes a restriction enzyme. Examples of suitable restriction enzymes for use include, but are not limited to BsiSI, Hin2I, MseI, Sau3A, RsaI, TspEI, MaeI, NiaIII, DpnI and the like. One methyl-sensitive enzyme is Hpa II that recognizes and cleaves at nonmethylated CCGG sequences but not at CCGG sequences where the outer cytosine is methylated. In this manner, a restriction enzyme can be selected that cleaves maternal, but not fetal DNA, or that cleaves fetal, but not maternal DNA. The difference in methylation between maternal and fetal DNA can be assessed and used to isolate fetal DNA by bisulfide treatment followed by either 1) sequencing, or 2) base-specific cleavage followed by mass spectrometric analysis as described in von Wintzingerode et al., 2002, PNAS, 99:7039-44, herein incorporated by reference in its entirety. These methods generally allow the detection and/or amplification of fetal DNA. Thus, in some embodiments, the methylation status of the maternal DNA is used to selectively degrade maternal DNA. For example, maternal DNA can be restricted by an appropriate enzyme and degraded, or bisulfite treatment can be utilized. Any method that selects for fetal DNA can be utilized.

Following the methylation-dependent isolation of fetal DNA, one or more of the relevant nucleic acid sequences (such as at least 15, 20, 25, 30, 40, 50, 60 or all of the nucleotides of at least one of the nucleic acid sequences set forth as SEQ ID NO: 1-68 or 83) from the fetal source may be distinguished from their counterparts from the maternal source. In some embodiments, the allelic ratio is determined.

In some examples, a single nucleotide polymorphism (SNP) that is located adjacent to the CpG containing sequence, is utilized. For example, the SNP can be at most 1,000, at most 150, at most 100 or at most 50 base pairs from the CpG containing genomic sequence in the maternal (and/or fetal) genome. In other embodiments, a STR that is located adjacent to the CpG containing sequence is utilized. For example, the SNP can be at most 1,000, at most 150, at most 100 or at most 50 base pairs from the CpG containing genomic sequence in the maternal (and/or fetal) genome.

In additional embodiments, a nucleic acid including a SNP, such as a bi-allelic (heterozygous SNP) can be used to detect the copy number of chromosome 13, 18 or 21 in the fetus. In some embodiments, the SNP is a bi-allelic SNP that is within 150 base pairs, within 140 base pairs, within 130 base pairs, with 120 base pairs, within 110 base pairs, within 100 base pairs, within 75 base pairs, within 50 base pairs or within 25 base pairs of at least one of SEQ ID NOs: 1-68 or 83, and can be used to detect the copy number of chromosome 13, 18 or 21 in the fetus. Generally, the number of base pairs is measured from the 5′ end of SEQ ID NO: 1-68 or SEQ ID NO: 83, or the 3′ end of SEQ ID NO: 1-68 or SEQ ID NO: 83, depending on whether the bi-allelic SNP is located 5′ or 3′ of SEQ ID NO: 1-68 or SEQ ID NO: 83, respectively. In additional embodiments, the bi-allelic SNP is identified using a heterozygosity cut-off of about 0.25, such as 0.25.

In further embodiments, the copy number of a short tandem repeat is determined in order to detect fetal anueploidy. Short tandem repeats (STR) are also bi-allelic in karyotypically normal individuals and may or may not be tri-allelic or mono-allelic in individuals with aneuploidy. Thus, the disclosed methods can also determine the copy number of short tandem repeats. In additional embodiments, a nucleic acid including a STR, such as a bi-allelic, tri-allelic or mon-allelic (heterozygous STR) can be used to detect the copy number of chromosome 13, 18 or 21 in the fetus. In some embodiments, the STR is within 150 base pairs, within 140 base pairs, within 130 base pairs, with 120 base pairs, within 110 base pairs, within 100 base pairs, within 75 base pairs, within 50 base pairs or within 25 base pairs of at least one of SEQ ID NOs: 1-68 or 83, and can be used to detect the copy number of chromosome 13, 18 or 21 in the fetus. Generally, the number of base pairs is measured from the 5′ end of SEQ ID NO: 1-68 or SEQ ID NO: 83, or the 3′ end of SEQ ID NO: 1-68 or SEQ ID NO: 83, depending on whether the STR is located 5′ or 3′ of SEQ ID NO: 1-68 or SEQ ID NO: 83, respectively. In additional embodiments, the bi-allelic, tri-allelic or mono-allelic STR is identified using a heterozygosity cut-off of about 0.25, such as 0.25.

An amplification reaction is optional prior to another analysis, such as a copy number and/or sequenced based analysis for a fetal marker (including, but not limited to, a single nucleotide polymorphism, as described above, or one or more of SEQ ID NOs: 1-68 and 83), after treatment by the methylation-dependent differential modification process. In some embodiments, the amplification is performed to preferentially amplify a fetal marker such as such as at least 15, 20, 25, 30, 40, 50, 60 or all of the nucleotides of at least one of the nucleic acid sequences set forth as SEQ ID NO: 1-68 and 83, or a nucleic acid including a SNP, such as a bi-allelic SNP that is within 150 base pairs, within 140 base pairs, within 130 base pairs, with 120 base pairs, within 110 base pairs, within 100 base pairs, within 75 base pairs, within 50 base pairs or within 25 base pairs of at least one of SEQ ID NOs: 1-68 and 83, or a short tandem repeat.

A variety of polynucleotide amplification methods are well established and frequently used in research. For instance, the general methods of polymerase chain reaction (PCR) for polynucleotide sequence amplification are well known in the art. Reviews of PCR methods, protocols, and principles in designing primers, are provided for example, in Innis, et al., PCR Protocols: A Guide to Methods and Applications, Academic Press, Inc. N.Y., 1990, which is incorporated herein by reference. PCR reagents and protocols are also available from commercial vendors, such as Roche Molecular Systems.

PCR can be carried out as an automated process with a thermostable enzyme. In this process, the temperature of the reaction mixture is cycled through a denaturing region, a primer annealing region, and an extension reaction region automatically. Machines specifically adapted for this purpose are commercially available. Although PCR amplification of a target polynucleotide sequence (e.g., that of such as at least 15, 20, 25, 30, 40, 50, 60 or all of the nucleotides of at least one of the nucleic acid sequences set forth as SEQ ID NO: 1-68 or 83, or a SNP or short tandem repeat within a certain distance of at least one of these sequences) is typically used in practicing the present invention, one of skill in the art will recognize that the amplification of a genomic sequence can be accomplished by any known method, such as ligase chain reaction (LCR), transcription-mediated amplification, and self-sustained sequence replication or nucleic acid sequence-based amplification (NASBA), each of which provides sufficient amplification. Branched-DNA technology can also be used to qualitatively demonstrate the presence of a particular genomic sequence (see Nolte, Adv. Clin. Chem. 33:201-235, 1998).

In some embodiments, the fetal DNA is sequenced. Techniques for polynucleotide sequence determination are also well established and widely practiced in the relevant research field. DNA sequencing methods are routinely practiced in research laboratories, either manual or automated, and can be used in the methods disclosed herein (see for example, Sambrook and Russell, Molecular Cloning, A Laboratory Manual (3rd ed. 2001); Kriegler, Gene Transfer and Expression: A Laboratory Manual (1990); and Current Protocols in Molecular Biology (Ausubel et al., eds., 1994)). However, there are additional protocols suitable for detecting changes in a polynucleotide sequence, or for determining copy number, that are of use. These methods include, but are not limited to, mass spectrometry, primer extension, polynucleotide hybridization, real-time PCR, and electrophoresis. The methods can include short read DNA sequencing, pyrosequencing, real time PCR or single molecule sequencing (for example, Pacific Biosciences methodology).

The presence and quantity of the fetal nucleic acids can be determined and compared to a standard control, such as the presence and quantity in a maternal sample, the presence and quantity in a fetal sample from a fetus known not to have aneuploidy, the presence and quantity in a fetal sample from a fetus known to have aneuploidy, or a standard value. Furthermore, once it is determined that one or more of these nucleic acids is of fetal origin that is indeed present in the sample, particularly when the amount of the gene(s) is greater than (or less than) a pre-determined threshold, the sample and its equivalents are deemed to contain a sufficient amount of fetal DNA for further analyses. The quantity of these particular nucleic acid sequences can be measured as fetal markers indicative of certain conditions.

In several embodiments, an aneuploidy of a chromosome, such as chromosomes 13, 18 or 21, is determined by assessing the copy number of the target polynucleotide sequence. This can be done using any method that quantifies changes in the allelic ratio. In several examples, MASSARRAY® by Sequenome, pyrosequencing and TAQMAN® (digital format), sequencing, hybridization, padlock (inversion) probes can be utilized. A copy number that is significantly different from 1:1, such as a copy number of 1:2 or 2:1 indicates that the fetus is anuepolid. In some examples, the target polynucleotide sequence is a 15, 20, 20, 40, 50 or 60 nucleotide sequences located within any one of SEQ ID NOs: 1-68 or 83. In other examples, the target polynucleotide sequence is SEQ ID NO: 1-68 or 83. In further examples, the target polynucleotide sequence includes a target SNP, such as a bi-allelic SNP that is within 150 base pairs, within 140 base pairs, within 130 base pairs, with 120 base pairs, within 110 base pairs, within 100 base pairs, within 75 base pairs, within 50 base pairs or within 25 base pairs of at least one of SEQ ID NOs: 1-68 or 83. Thus, the SNP can be at most 150 base pairs, within 140 base pairs, within 130 base pairs, with 120 base pairs, within 110 base pairs, within 100 base pairs, within 75 base pairs, within 50 base pairs or within 25 base pairs from one of SEQ ID NOs: 1-68 or 83. In more examples, the target polynucleotide sequence is a short tandem repeat that is within 150 base pairs, within 140 base pairs, within 130 base pairs, with 120 base pairs, within 110 base pairs, within 100 base pairs, within 75 base pairs, within 50 base pairs or within 25 base pairs of at least one of SEQ ID NOs: 1-68 or 83.

Exemplary SNPs are provided below. The Rs. Id number and position information is provided; sequence information for these SNPs is incorporated by reference herein as available on Jun. 30, 2010. Information can also be found at the NCBI Single Nucleotide Polymorphism website. The SEQ ID NO: 2 that can be used with each SNP (see above) is indicated.

The following exemplary SNPs can be used to detect fetal aneuploidy of chromosome 21:

Sequence 42 chromosome 21 (SEQ ID NO: 1) Rs.id 914232, snp.pos 45777178 (snp150_c21_mc_flank.csv) Sequence 45 chromosome 21(SEQ ID NO: 2) Rs.id 12627387, snp.pos 42355995 (snp150_c21_mc_flank.csv) Sequence 16 chromosome 21(SEQ ID NO: 3) Rs.id 225395, no snp.pos (snp150_c21_cm_flank.csv) Sequence 69 chromosome 21 (SEQ ID NO: 4) Rs.id 2013275, snp.pos 45158900 (snp150_c21_mc_flank.csv) Sequence 76 chromosome 21(SEQ ID NO: 5) Rs.id 2255526, snp.pos 46795967 (snp_(—)150_c21_mc_flank.csv) Sequence 88 chromosome 21 (SEQ ID NO: 6) Rs.id 1539757, snp.pos 31559784 (snp150_c21_mc_flank.csv) Sequence 99 chromosome 21 (SEQ ID NO: 7) Rs.id 2838434, snp.pos 44161580 (snp150_c21_mc_flank.csv) The following exemplary SNPs can be used to detect fetal aneuploidy of chromosome 13:

Row 2 (SEQ ID NO: 9)

Rs.id 9542537, no snp.pos (snp150_c13_cm_flank.csv)

Row 4 (SEQ ID NO: 10)

Rs.id 7983181, no snp.pos (snp150 c13_cm_flank.csv)

Row 6 (SEQ ID NO: 11)

Rs.id 166710, no snp.pos (snp150_c13_cm_flank.csv)

Row 8 (SEQ ID NO: 12)

Rs.id 9301803 or 9301804, no snp.pos (snp150_c13_cm_flank.csv)

Row 12 (SEQ ID NO: 13)

Rs.id 2025675, no snp.pos (snp150_c13_cm_flank.csv)

Row 14 (SEQ ID NO: 14)

Rs.id 11617606, no snp.pos (snp150_c13_cm_flank.csv)

Row 16 (SEQ ID NO: 15)

Rs.id 9535813 or 9316563, no snp.pos (snp150_c13_cm_flank.csv)

Row 20(SEQ ID NO: 16)

Rs.id 980094 or 2389355, no snp.pos (snp150_c13_cm_flank.csv)

Row 24 (SEQ ID NO: 17)

Rs.id 9536376, no snp.pos (snp150_c13_cm_flank.csv)

Row 26 (SEQ ID NO: 18)

Rs.id 9572623, no snp.pos (snp150_c13_cm_flank.csv) The following exemplary SNPs can be used to detect aneuploidy of chromosome 18:

Row 2 (SEQ ID NO: 19)

Rs.id 12955286 or 1852531, no snp.pos (snp150_c18_cm_flank.csv)

Row 6 (SEQ ID NO: 20)

Rs.id 1244833, no snp.pos (snp150_c18_cm_flank.csv)

Row 8 (SEQ ID NO: 21)

Rs.id 2923220, no snp.pos (snp150_c18_cm_flank.csv)

Row 10 (SEQ ID NO: 22)

Rs.id 16977803, no snp.pos (snp150_c18_cm_flank.csv)

Row 12 9(SEQ ID NO: 23)

Rs.id 603884, no snp.pos (snp150_c18_cm_flank.csv)

Row 14 (SEQ ID NO: 24)

Rs.id 4800573, no snp.pos (snp150_c18_cm_flank.csv)

Row 16 (SEQ ID NO: 25)

Rs.id 12970409 (snp150_c18_cm_flank.csv)

Row 18 (SEQ ID NO: 26)

Rs.id 11663168 or 11663172 (snp150_c18_cm_flank.csv)

Row 22 (SEQ ID NO: 27)

Rs.id 7505859 (snp150_c18_cm_flank.csv)

Row 24 (SEQ ID NO: 28)

Rs.id 8095592 (snp150_c18_cm_flank.csv) The following exemplary SNPs can be used to detect aneuploidy of chromosome 21:

Row 2 (SEQ ID NO: 29)

Rs.id 225395 (snp150_c21_cm_flank.csv)

Row 4 (SEQ ID NO: 30)

Rs.id 2837528 (snp150_c21_cm_flank.csv)

Row 6 (SEQ ID NO: 31)

Rs.id 2827557 (snp150_c21_cm_flank.csv)

Row 8 (SEQ ID NO: 32)

Rs.id 2822564 (snp150_c21_cm_flank.csv)

Row 10 (SEQ ID NO: 33)

Rs.id 233895 (snp150_c21_cm_flank.csv)

Row 12(SEQ ID NO: 34)

Rs.id 9980448 (snp150_c21_cm_flank.csv)

Row 14 (SEQ ID NO: 35)

Rs.id 2827384 (snp150_c21_cm_flank.csv)

Row 16 (SEQ ID NO: 36)

Rs.id 20457173 (snp150_c21_cm_flank.csv)

Row 18 (SEQ ID NO: 37)

Rs.id 9977149 (snp150_c21_cm_flank.csv)

Row 20 (SEQ ID NO: 38)

Rs.id 3453 (snp150_c21_cm flank. Csv)

The following exemplary SNPs can be used to detect fetal aneuploidy of chromosome 13:

Row 2 (SEQ ID NO: 39)

Rs.id 7317471, snp.pos 20518084 (snp150_c13_mc_flank.csv)

Row 4 (SEQ ID NO: 40)

Rs.id 3742160, snp.pos 105943830 (snp150_c13_mc_flank.csv)

Row 6 (SEQ ID NO: 41)

Rs.id 206321, snp.pos 31888780 (snp150_c13_mc_flank.csv)

Row 8 (SEQ ID NO: 42)

Rs.id 9579199 or 9578047, snp.pos 28062783 or 28062731 (snp150_c13_mc_flank.csv)

Row 12 (SEQ ID NO: 43)

Rs.id 9506534, snp.pos 20145165 (snp150_c13 mc_flank.csv)

Row 14 (SEQ ID NO: 44)

Rs.id 1411551, snp.pos 109171036 (snp150_c13_mc_flank.csv)

Row 17 (SEQ ID NO: 45)

Rs.id 9515119, snp.pos 109207337 (snp150_c13_mc_flank.csv)

Row 19 (SEQ ID NO: 46)

Rs.id 9551454, snp.pos 27730987 (snp150_c13_mc_flank.csv)

Row 21 (SEQ ID NO: 47)

Rs.id 17593586, snp.pos 40693966 (snp150_c13_mc_flank.csv)

Row 23 (SEQ ID NO: 48)

Rs.id 166753, snp.pos 108544047 (snp150_c13_mc_flank.csv)

The following exemplary SNPs can be used to detect fetal aneuploidy of chromosome 18:

Row 2 (SEQ ID NO: 49)

Rs.id 8083921, snp.pos 58917082 (snp150 c18_mc_flank.csv)

Row 4 (SEQ ID NO: 50)

Rs.id 546680, snp.pos 30988098 (snp150_c18_mc_flank.csv)

Row 6 (SEQ ID NO: 51)

Rs.id 4891159, snp.pos 72230929 (snp150_c18_mc_flank.csv)

Row 8 (SEQ ID NO: 52)

Rs.id 16978450, snp.pos 41517284 (snp150 c 8 flank.csv)

Row 10 (SEQ ID NO: 53)

Rs.id 7245283, snp.pos 957483 (snp150_c18_mc_flank.csv)

Row 12 (SEQ ID NO: 54)

Rs.id 9945379, snp.pos 10928309 (snp150_c18_mc_flank.csv)

Row 14 (SEQ ID NO: 55)

Rs.id 12958513 or 16978452 or 7228161, snp.pos 41520914 or 41521069 or 41520883 (snp150_c18_mc_flank.csv)

Row 21 (SEQ ID NO: 56)

Rs.id 11152348, snp.pos 58349472 (snp150 c18 mc_flank.csv)

Row 23 (SEQ ID NO: 57)

Rs.id 528129, snp.pos 24748157 (snp150_c18_mc_flank.csv)

Row 25 (SEQ ID NO: 58)

Rs.id 16978485 or 9966818, snp.pos 41589920 or 41589897 (snp150 c18_mc_flank.csv)

The following exemplary SNPs can be used to detect fetal aneuploidy of chromosome 21:

Row 2 (SEQ ID NO: 59)

Rs.id 11702354, snp.pos 34806395 (snp150_c21_mc_flank.csv)

Row 4 (SEQ ID NO: 60)

Rs.id 11702450, snp.pos 46528077 (snp150_c21_mc_flank.csv)

Row 6 (SEQ ID NO: 61)

Rs.id 2839418, snp.pos 42192853 (snp150_c21_mc_flank.csv)

Row 8 (SEQ ID NO: 62)

Rs.id 6517531, snp.pos 39559517 (snp150_c21_mc_flank.csv)

Row 10 (SEQ ID NO: 63)

Rs.id 2824493, snp.pos 18087813 (snp150_c21_mc_flank.csv)

Row 12 (SEQ ID NO: 64)

Rs.id 2835676, snp.pos 37513181 (snp150_c21 mc_flank.csv)

Row 14 (SEQ ID NO: 65)

Rs.id 2823026, snp.pos 15346340 (snp150_c21_mc_flank.csv)

Row 16 (SEQ ID NO: 66)

Rs.id 6517254 or 2070368, snp.pos 35002160 or 35002268 (snp150_c21_mc_flank.csv)

Row 20 (SEQ ID NO: 67)

Rs.id 220269, snp.pos 42357265 (snp150_c21_mc_flank.csv)

Row 22 (SEQ ID NO: 68)

Rs.id 2823304, snp.pos 15784966 (snp150_c21_mc_flank.csv) In some embodiments, the methods disclosed herein utilize at least 1, at least 5, at least 10, at least 15, at least 20, at least 30, at least 40, at least 50 or at least 60 nucleotides of these SNPs.

In some embodiments, once a the fetus is diagnosed with aneuploidy, such as a trisomy or a monosomy, an indication of that diagnosis can be displayed and/or conveyed to a clinician or other caregiver. For example, the results of the test are provided to a user (such as a clinician or other health care worker, laboratory personnel, or patient) in a perceivable output that provides information about the results of the test. In some examples, the output is a paper output (for example, a written or printed output), a display on a screen, a graphical output (for example, a graph, chart, voltammetric trace, or other diagram), or an audible output.

Molecular Methods for Detection of Nucleic Acids

Polymorphisms, such as SNPs, also can be used to detect the allele frequency both in the maternal sample and the fetal sample. Generally, the methods disclosed herein involve an assessment of nucleic acid sequence. Molecular techniques of use in all of these methods are disclosed below.

Preparation of Nucleic Acids for Analysis: Nucleic Acid Molecules can be prepared for analysis using any technique known to those skilled in the art. Generally, such techniques result in the production of a nucleic acid molecule sufficiently pure to determine the presence or absence of one or more variations at one or more locations in the nucleic acid molecule. Such techniques are described for example, in Sambrook, et al., Molecular Cloning: A Laboratory Manual (Cold Spring Harbor Laboratory, New York) (1989), and Ausubel, et al., Current Protocols in Molecular Biology (John Wiley and Sons, New York) (1997), incorporated herein by reference.

When the nucleic acid of interest is present in a cell, it can be necessary to first prepare an extract of the cell and then perform further steps, such as differential precipitation, column chromatography, extraction with organic solvents and the like, in order to obtain a sufficiently pure preparation of nucleic acid. Extracts can be prepared using standard techniques in the art, for example, by chemical or mechanical lysis of the cell. Extracts then can be further treated, for example, by filtration and/or centrifugation and/or with chaotropic salts such as guanidinium isothiocyanate or urea or with organic solvents such as phenol and/or HCCl₃ to denature any contaminating and potentially interfering proteins. When chaotropic salts are used, it can be desirable to remove the salts from the nucleic acid-containing sample. This can be accomplished using standard techniques in the art such as precipitation, filtration, size exclusion chromatography and the like.

Amplification of nucleic acid molecules: Optionally, the nucleic acid samples obtained from the subject are amplified prior to detection. Target nucleic acids are amplified to obtain amplification products, including a DNA that includes a SNP, from the sample prior to detection.

Any nucleic acid amplification method can be used. An example of in vitro amplification is the polymerase chain reaction (PCR), in which a biological sample obtained from a subject is contacted with a pair of oligonucleotide primers, under conditions that allow for hybridization of the primers to a nucleic acid molecule in the sample. The primers are extended under suitable conditions, dissociated from the template, and then re-annealed, extended, and dissociated to amplify the number of copies of the nucleic acid molecule. Other examples of in vitro amplification techniques include quantitative real-time PCR, strand displacement amplification (see U.S. Pat. No. 5,744,311); transcription-free isothermal amplification (see U.S. Pat. No. 6,033,881); repair chain reaction amplification (see PCT Publication NO. WO 90/01069); ligase chain reaction amplification (see EP-A-320 308); gap filling ligase chain reaction amplification (see U.S. Pat. No. 5,427,930); coupled ligase detection and PCR (see U.S. Pat. No. 6,027,889); and NASBA™ RNA transcription-free amplification (see U.S. Pat. No. 6,025,134).

In specific examples, the target sequences to be amplified from the subject include a nucleotide sequence of interest including the SNP. In certain embodiments, target sequences containing one or more of SEQ ID NOs: 1-68, or genetic region within, for example, 150 base pairs of one of SEQ ID NO: 1-68 are amplified. In an embodiment, a single SNP with exceptionally high predictive value is amplified.

A pair of primers can be utilized in the amplification reaction. One or both of the primers can be labeled, for example with a detectable radiolabel, fluorophore, or biotin molecule. The pair of primers includes an upstream primer (which binds 5′ to the downstream primer) and a downstream primer (which binds 3′ to the upstream primer). The pair of primers used in the amplification reactions are selective primers which permit amplification of a size related marker locus. Primers can be selected to amplify a DNA including a SNP. Numerous primers can be designed by those of skill in the art simply by determining the sequence of the desired target region, for example, using well known computer assisted algorithms that select primers within desired parameters suitable for annealing and amplification.

If desired, an additional pair of primers can be included in the amplification reaction as an internal control. For example, these primers can be used to amplify a “housekeeping” nucleic acid molecule, and serve to provide confirmation of appropriate amplification. In another example, a target nucleic acid molecule including primer hybridization sites can be constructed and included in the amplification reactor. One of skill in the art will readily be able to identify primer pairs to serve as internal control primers.

Primer Design Strategy: Increased use of polymerase chain reaction (PCR) methods has stimulated the development of many programs to aid in the design or selection of oligonucleotides used as primers for PCR. Four examples of such programs that are freely available via the Internet are: PRIMER™ by Mark Daly and Steve Lincoln of the Whitehead Institute (UNIX, VMS, DOS, and Macintosh), Oligonucleotide Selection Program by Phil Green and LaDeana Hiller of Washington University in St. Louis (UNIX, VMS, DOS, and Macintosh), PGEN™ by Yoshi (DOS only), and Amplify by Bill Engels of the University of Wisconsin (Macintosh only). Generally these programs help in the design of PCR primers by searching for bits of known repeated-sequence elements and then optimizing the T_(m) by analyzing the length and GC content of a putative primer. Commercial software is also available and primer selection procedures are rapidly being included in most general sequence analysis packages.

Designing oligonucleotides for use as either sequencing or PCR primers to detect requires selection of an appropriate sequence that specifically recognizes the target, and then testing the sequence to eliminate the possibility that the oligonucleotide will have a stable secondary structure. Inverted repeats in the sequence can be identified using a repeat-identification or RNA-folding programs. If a possible stem structure is observed, the sequence of the primer can be shifted a few nucleotides in either direction to minimize the predicted secondary structure. When the amplified sequence is intended for subsequence cloning, the sequence of the oligonucleotide can also be compared with the sequences of both strands of the appropriate vector and insert DNA. A sequencing primer only has a single match to the target DNA. It is also advisable to exclude primers that have only a single mismatch with an undesired target DNA sequence. For PCR primers used to amplify genomic DNA, the primer sequence can be compared to the sequences in the GENBANK™ database to determine if any significant matches occur. If the oligonucleotide sequence is present in any known DNA sequence or, more importantly, in any known repetitive elements, the primer sequence should be changed.

Detection of alleles: The nucleic acids obtained from the sample can be genotyped to identify the particular allele present for a marker locus. A sample of sufficient quantity to permit direct detection of marker alleles from the sample can be obtained from the subject. Alternatively, a smaller sample is obtained from the subject and the nucleic acids are amplified prior to detection. Any target nucleic acid that is informative for a chromosome haplotype can be detected. Generally, the target nucleic acid corresponds to a SNP. Any method of detecting a nucleic acid molecule can be used, such as hybridization and/or sequencing assays.

Hybridization is the binding of complementary strands of DNA, DNA/RNA, or RNA. Hybridization can occur when primers or probes bind to target sequences such as target sequences within genomic DNA. Probes and primers that are useful generally include nucleic acid sequences that hybridize (for example under high stringency conditions) with a nucleic acid sequence including the SNP of interest, but do not hybridize to a reference allele, or that hybridize to the reference allele, but do not hybridize to the SNP. Physical methods of detecting hybridization or binding of complementary strands of nucleic acid molecules, include but are not limited to, such methods as DNase I or chemical footprinting, gel shift and affinity cleavage assays, Southern and Northern blotting, dot blotting and light absorption detection procedures. The binding between a nucleic acid primer or probe and its target nucleic acid is frequently characterized by the temperature (T_(m)) at which 50% of the nucleic acid probe is melted from its target. A higher (T_(m)) means a stronger or more stable complex relative to a complex with a lower (Tm).

Generally, complementary nucleic acids form a stable duplex or triplex when the strands bind, (hybridize), to each other by forming Watson-Crick, Hoogsteen or reverse Hoogsteen base pairs. Stable binding occurs when an oligonucleotide molecule remains detectably bound to a target nucleic acid sequence under the required conditions.

Complementarity is the degree to which bases in one nucleic acid strand base pair with the bases in a second nucleic acid strand. Complementarity is conveniently described by percentage, that is, the proportion of nucleotides that form base pairs between two strands or within a specific region or domain of two strands. For example, if 10 nucleotides of a 15-nucleotide oligonucleotide faun base pairs with a targeted region of a DNA molecule, that oligonucleotide is said to have 66.67% complementarity to the region of DNA targeted.

In the present disclosure, “sufficient complementarity” means that a sufficient number of base pairs exist between an oligonucleotide molecule and a target nucleic acid sequence (such as a SNP) to achieve detectable and specific binding. When expressed or measured by percentage of base pairs formed, the percentage complementarity that fulfills this goal can range from as little as about 50% complementarity to full (100%) complementary. In general, sufficient complementarity is at least about 50%, for example at least about 75% complementarity, at least about 90% complementarity, at least about 95% complementarity, at least about 98% complementarity, or even at least about 100% complementarity. The qualitative and quantitative considerations involved in establishing binding conditions that allow one skilled in the art to design appropriate oligonucleotides for use under the desired conditions is provided by Beltz et al. Methods Enzymol 100:266-285, 1983, and by Sambrook et al. (ed.), Molecular Cloning: A Laboratory Manual, 2nd ed., vol. 1-3, Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y., 1989.

Hybridization conditions resulting in particular degrees of stringency will vary depending upon the nature of the hybridization method and the composition and length of the hybridizing nucleic acid sequences. Generally, the temperature of hybridization and the ionic strength (such as the Na⁺ concentration) of the hybridization buffer will determine the stringency of hybridization. Calculations regarding hybridization conditions for attaining particular degrees of stringency are discussed in Sambrook et al., (1989) Molecular Cloning: a laboratory manual, second edition, Cold Spring Harbor Laboratory, Plainview, N.Y. (chapters 9 and 11). The following is an exemplary set of hybridization conditions and is not limiting:

Very High Stringency (Detects Sequences that Share at Least 90% Complementarity)

Hybridization: 5×SSC at 65° C. for 16 hours

Wash twice: 2×SSC at room temperature (RT) for 15 minutes each

Wash twice: 0.5×SSC at 65° C. for 20 minutes each

High Stringency (Detects Sequences that Share at Least 80% Complementarity)

Hybridization: 5×-6×SSC at 65° C.-70° C. for 16-20 hours

Wash twice: 2×SSC at RT for 5-20 minutes each

Wash twice: 1×SSC at 55° C.-70° C. for 30 minutes each

Low Stringency (Detects Sequences that Share at Least 50% Complementarity)

Hybridization: 6×SSC at RT to 55° C. for 16-20 hours

Wash at least twice: 2×-3×SSC at RT to 55° C. for 20-30 minutes each.

Methods for labeling nucleic acid molecules so they can be detected are well known. Examples of such labels include non-radiolabels and radiolabels. Non-radiolabels include, but are not limited to an enzyme, chemiluminescent compound, fluorescent compound (such as FITC, Cy3, and Cy5), metal complex, hapten, enzyme, colorimetric agent, a dye, or combinations thereof. Radiolabels include, but are not limited to, ¹²⁵I, ³²P and ³⁵S. For example, radioactive and fluorescent labeling methods, as well as other methods known in the art, are suitable for use with the present disclosure. In one example, primers used to amplify the subject's nucleic acids are labeled (such as with biotin, a radiolabel, or a fluorophore). In another example, amplified target nucleic acid samples are end-labeled to form labeled amplified material. For example, amplified nucleic acid molecules can be labeled by including labeled nucleotides in the amplification reactions.

Nucleic acid molecules corresponding to one or more SNPs or alleles including the SNP can also be detected by hybridization procedures using a labeled nucleic acid probe, such as a probe that detects only one alternative allele at a marker locus. Most commonly, the target nucleic acid (or amplified target nucleic acid) is separated based on size or charge and transferred to a solid support. The solid support (such as membrane made of nylon or nitrocellulose) is contacted with a labeled nucleic acid probe, which hybridizes to it complementary target under suitable hybridization conditions to form a hybridization complex.

Hybridization conditions for a given combination of array and target material can be optimized routinely in an empirical manner close to the T_(m) of the expected duplexes, thereby maximizing the discriminating power of the method. For example, the hybridization conditions can be selected to permit discrimination between matched and mismatched oligonucleotides. Hybridization conditions can be chosen to correspond to those known to be suitable in standard procedures for hybridization to filters (and optionally for hybridization to arrays). In particular, temperature is controlled to substantially eliminate formation of duplexes between sequences other than an exactly complementary allele of the selected marker. A variety of known hybridization solvents can be employed, the choice being dependent on considerations known to one of skill in the art (see U.S. Pat. No. 5,981,185).

Once the target nucleic acid molecules have been hybridized with the labeled probes, the presence of the hybridization complex can be analyzed, for example by detecting the complexes.

Methods for detecting hybridized nucleic acid complexes are well known in the art. In one example, detection includes detecting one or more labels present on the oligonucleotides, the target (e.g., amplified) sequences, or both. Detection can include treating the hybridized complex with a buffer and/or a conjugating solution to effect conjugation or coupling of the hybridized complex with the detection label, and treating the conjugated, hybridized complex with a detection reagent. In one example, the conjugating solution includes streptavidin alkaline phosphatase, avidin alkaline phosphatase, or horseradish peroxidase. Specific, non-limiting examples of conjugating solutions include streptavidin alkaline phosphatase, avidin alkaline phosphatase, or horseradish peroxidase. The conjugated, hybridized complex can be treated with a detection reagent. In one example, the detection reagent includes enzyme-labeled fluorescence reagents or calorimetric reagents. In one specific non-limiting example, the detection reagent is enzyme-labeled fluorescence reagent (ELF) from Molecular Probes, Inc. (Eugene, Oreg.). The hybridized complex can then be placed on a detection device, such as an ultraviolet (UV) transilluminator (manufactured by UVP, Inc. of Upland, Calif.). The signal is developed and the increased signal intensity can be recorded with a recording device, such as a charge coupled device (CCD) camera (manufactured by Photometrics, Inc. of Tucson, Ariz.). In particular examples, these steps are not performed when radiolabels are used. In particular examples, the method further includes quantification, for instance by determining the amount of hybridization.

Allele Specific PCR: Allele-specific PCR differentiates between target regions differing in the presence of absence of a variation or polymorphism. PCR amplification primers are chosen based upon their complementarity to the target sequence, such as nucleic acid sequence in a DNA including a SNP, a specified region of an allele including a SNP, or to the SNP itself. The primers bind only to certain alleles of the target sequence. This method is described by Gibbs, Nucleic Acid Res. 17:12427 2448, 1989, herein incorporated by reference.

Allele Specific Oligonucleotide Screening Methods: Further screening methods employ the allele-specific oligonucleotide (ASO) screening methods (e.g. see Saiki et al., Nature 324:163-166, 1986). Oligonucleotides with one or more base pair mismatches are generated for any particular allele or haplotype block. ASO screening methods detect mismatches between one allele (or haplotype block) in the target genomic or PCR amplified DNA and the other allele (or haplotype block), showing decreased binding of the oligonucleotide relative to the second allele (i.e. the other allele) oligonucleotide. Oligonucleotide probes can be designed that under low stringency will bind to both polymorphic forms of the allele, but which at high stringency, only bind to the allele to which they correspond. Alternatively, stringency conditions can be devised in which an essentially binary response is obtained, i.e., an ASO corresponding to a variant form of the target gene will hybridize to that allele (haplotype block), and not to the reference allele (haplotype block).

Ligase Mediated Allele Detection Method: Ligase can also be used to detect point mutations, such as the tag SNPs disclosed herein, in a ligation amplification reaction (e.g. as described in Wu et al., Genomics 4:560-569, 1989). The ligation amplification reaction (LAR) utilizes amplification of specific DNA sequence using sequential rounds of template dependent ligation (e.g. as described in Wu, supra, and Barany, Proc. Nat. Acad. Sci. 88:189-193, 1990).

Denaturing Gradient Gel Electrophoresis: Amplification products generated using the polymerase chain reaction can be analyzed by the use of denaturing gradient gel electrophoresis. Different alleles (haplotype blocks) can be identified based on the different sequence-dependent melting properties and electrophoretic migration of DNA in solution. DNA molecules melt in segments, termed melting domains, under conditions of increased temperature or denaturation. Each melting domain melts cooperatively at a distinct, base-specific melting temperature (T_(M)). Melting domains are at least 20 base pairs in length, and can be up to several hundred base pairs in length.

Differentiation between alleles (haplotype blocks) based on sequence specific melting domain differences can be assessed using polyacrylamide gel electrophoresis, as described in Chapter 7 of Erlich, ed., PCR Technology, Principles and Applications for DNA Amplification, W. H. Freeman and Co., New York (1992).

Generally, a target region to be analyzed by denaturing gradient gel electrophoresis is amplified using PCR primers flanking the target region. The amplified PCR product is applied to a polyacrylamide gel with a linear denaturing gradient as described in Myers et al., Meth. Enzymol. 155:501-527, 1986, and Myers et al., in Genomic Analysis, A Practical Approach, K. Davies Ed. IRL Press Limited, Oxford, pp. 95 139, 1988. The electrophoresis system is maintained at a temperature slightly below the Tm of the melting domains of the target sequences.

In an alternative method of denaturing gradient gel electrophoresis, the target sequences can be initially attached to a stretch of GC nucleotides, termed a GC clamp, as described in Chapter 7 of Erlich, supra. In one example, at least 80% of the nucleotides in the GC clamp are either guanine or cytosine. In another example, the GC clamp is at least 30 bases long. This method is particularly suited to target sequences with high T_(m)'s.

Generally, the target region is amplified by polymerase chain reaction. One of the oligonucleotide PCR primers carries at its 5′ end, the GC clamp region, at least 30 bases of the GC rich sequence, which is incorporated into the 5′ end of the target region during amplification. The resulting amplified target region is run on an electrophoresis gel under denaturing gradient conditions. DNA fragments differing by a single base change will migrate through the gel to different positions, which can be visualized by ethidium bromide staining.

Temperature Gradient Gel Electrophoresis: Temperature gradient gel electrophoresis (TGGE) is based on the same underlying principles as denaturing gradient gel electrophoresis, except the denaturing gradient is produced by differences in temperature instead of differences in the concentration of a chemical denaturant. Standard TGGE utilizes an electrophoresis apparatus with a temperature gradient running along the electrophoresis path. As samples migrate through a gel with a uniform concentration of a chemical denaturant, they encounter increasing temperatures. An alternative method of TGGE, temporal temperature gradient gel electrophoresis (TTGE or tTGGE) uses a steadily increasing temperature of the entire electrophoresis gel to achieve the same result. As the samples migrate through the gel the temperature of the entire gel increases, leading the samples to encounter increasing temperature as they migrate through the gel. Preparation of samples, including PCR amplification with incorporation of a GC clamp, and visualization of products are the same as for denaturing gradient gel electrophoresis. Single-Strand Conformation Polymorphism Analysis: Target sequences, such as alleles can be differentiated using single-strand conformation polymorphism analysis, which identifies base differences by alteration in electrophoretic migration of single stranded PCR products, for example as described in Orita et al., Proc. Nat. Acad. Sci. 85:2766-2770, 1989. Amplified PCR products can be generated as described above, and heated or otherwise denatured, to form single stranded amplification products. Single-stranded nucleic acids can refold or form secondary structures which are partially dependent on the base sequence. Thus, electrophoretic mobility of single-stranded amplification products can detect base-sequence difference between alleles.

Chemical or Enzymatic Cleavage of Mismatches: Quantitative differences between target sequences, such as alleles, can also be detected by differential chemical cleavage of mismatched base pairs, for example as described in Grompe et al., Am. J. Hum. Genet. 48:212-222, 1991. In another method, differences between target sequences, such as alleles, can be detected by enzymatic cleavage of mismatched base pairs, as described in Nelson et al., Nature Genetics 4:11-18, 1993. Briefly, genetic material from an animal and an affected family member can be used to generate mismatch free heterohybrid DNA duplexes. As used herein, “heterohybrid” means a DNA duplex strand comprising one strand of DNA from one animal, and a second DNA strand from another animal, usually an animal differing in the phenotype for the trait of interest. Positive selection for heterohybrids free of mismatches allows determination of small insertions, deletions or other polymorphisms.

Non-gel Systems: Other possible techniques include non-gel systems such as TaqMan™ (Perkin Elmer). In this system oligonucleotide PCR primers are designed that flank the mutation in question and allow PCR amplification of the region. A third oligonucleotide probe is then designed to hybridize to the region containing the base subject to change between different alleles of the gene. This probe is labeled with fluorescent dyes at both the 5′ and 3′ ends. These dyes are chosen such that while in this proximity to each other the fluorescence of one of them is quenched by the other and cannot be detected. Extension by Taq DNA polymerase from the PCR primer positioned 5′ on the template relative to the probe leads to the cleavage of the dye attached to the 5′ end of the annealed probe through the 5′ nuclease activity of the Taq DNA polymerase. This removes the quenching effect allowing detection of the fluorescence from the dye at the 3′ end of the probe. The discrimination between different DNA sequences arises through the fact that if the hybridization of the probe to the template molecule is not complete (there is a mismatch of some form) the cleavage of the dye does not take place. Thus only if the nucleotide sequence of the oligonucleotide probe is completely complimentary to the template molecule to which it is bound will quenching be removed. A reaction mix can contain two different probe sequences each designed against different alleles that might be present thus allowing the detection of both alleles in one reaction.

Non-PCR Based Allele detection: The identification of a DNA sequence can be made without an amplification step, based on polymorphisms including restriction fragment length polymorphisms in a subject and a control, such as a family member. Hybridization probes are generally oligonucleotides which bind through complementary base pairing to all or part of a target nucleic acid. Probes typically bind target sequences lacking complete complementarity with the probe sequence depending on the stringency of the hybridization conditions. The probes can be labeled directly or indirectly, such that by assaying for the presence or absence of the probe, one can detect the presence or absence of the target sequence. Direct labeling methods include radioisotope labeling, such as with ³²P or ³⁵S. Indirect labeling methods include fluorescent tags, biotin complexes which can be bound to avidin or streptavidin, or peptide or protein tags. Visual detection methods include photoluminescents, Texas red, rhodamine and its derivatives, red leuco dye and 3,3′,5,5′-tetramethylbenzidine (TMB), fluorescein, and its derivatives, dansyl, umbelliferone and the like or with horse radish peroxidase, alkaline phosphatase and the like.

Hybridization probes include any nucleotide sequence capable of hybridizing to a nucleic acid sequence wherein a polymorphism, such as a tag SNP, and thus defining a genetic marker, including a restriction fragment length polymorphism, a hypervariable region, repetitive element, or a variable number tandem repeat. Hybridization probes can be any gene or a suitable analog. Further suitable hybridization probes include exon fragments or portions of cDNAs or genes known to map to the relevant region of the chromosome.

Exemplary tandem repeat hybridization probes for use in the methods disclosed are those that recognize a small number of fragments at a specific locus at high stringency hybridization conditions, or that recognize a larger number of fragments at that locus when the stringency conditions are lowered.

The present methods can also be embodied in a device or a system comprising one or more such devices, which is capable of carrying out all or some of the method steps described herein.

The disclosure is illustrated by the following non-limiting Examples.

EXAMPLES

Prenatal screening for Down's Syndrome and other chromosomal abnormalities is most effectively achieved using interventional procedures such as amniocentesis and chorionic villus sampling (CVS) that obtain fetal or placental cells (respectively) for karyotype analysis. Unfortunately, these procedures involve a risk of spontaneous abortion that has been reported to be as high as 1% (Mujezinovic and Alfirevic, Obst. Gyn. 110: 687-694, 2007) (although complication rates have fallen recently) and are generally only routinely offered to expectant mothers who have an elevated risk of carrying an aneuploid fetus. Minimally invasive screening protocols utilizing specific protein markers detectable in maternal serum in combination with ultrasound have been in use for a number of years but these do not achieve desirable levels of sensitivity and specificity and so are not definitive (Summers et al., J. Med. Screen. 10: 107-11, 2003a, Meier et al., Prenat. Diagn. 23: 443-446, 2003, Summers et al., Obstet. Bynecol. 101: 1301-1308, 2003b). Furthermore, these markers are only surrogates of the underlying genetic abnormality.

As described herein, a high-throughput approach was used to characterize DNA methylation patterns of CVS and MBCs obtained during the first trimester of pregnancy. The biomarker discovery efforts on chromosomes 13, 18 and 21, which are frequently found to be aneuploid in live births. A list of epigenetic biomarkers was established, wherein these biomarkers each display differential methylation patterns between these tissues on human chromosomes 13, 18 and 21. A custom microarray is also disclosed. The data presented herein provide a useful and unique catalogue of tissue-specific methylation patterns that can be used for fetal diagnosis.

Human chromosomal abnormalities are relatively common, occurring in approximately 10-30% of conceptions. It has been estimated that 1 in 300 live-born infants are aneuploid and that this figure rises to 1 in 25 for stillborn infants. By far the commonest form of aneuploidy is trisomy 21 resulting in Down syndrome, which occurs at an average rate of approximately 1 of 500 live births and 1 of 250 conceptions (Hook, Lancet 340: 1109, 1992, Crotty et al., May Clin. Proc. 67: 373-378, 1992). Other common autosomal trisomies including trisomy 18 (Edward syndrome) and trisomy 13 (Patau syndrome) occur with birth incidences of 11n 6,500 and 1 in 12,500 (Spencer, Am. J. Med. Med. Genet. C. Semin. Med. GEnet. 145C: 18-32, 2007, Hassold et al., Environ. Mol. Mutagen. 28: 167-175, 1996).

Example 1 Materials and Methods

Tissue Handling and DNA Extraction: All samples used in the studies described below were de-identified discarded tissues. CVS samples were obtained between gestational weeks 11 and 13. Samples were dissected under a microscope and separated from any decidua or flecks of blood. The culture media was removed and the tissue placed in 1.5-2.0 mL microcentrifuge tubes before freezing at −80° C. until DNA was extracted. To extract the DNA, one 5 mm stainless steel bead and 180 μL buffer ATL (from Qiagen's DNEASY® Blood and Tissue kit) were added to each CVS sample. The samples were placed in the TISSUELYSER® (Qiagen) Adaptor set 2×24, and the TISSUELYSER® was operated for 20 seconds at 30 Hz. The DNA was then purified using the DNEASY® Blood and Tissue kit as per the manufacturer's protocol. MBCs were obtained between gestational weeks 11 and 13. DNA was extracted from the MBC's using a modified protocol previously described by Iovannisci, et al., 2006 (Iovannisci et al., 2006), using reagents from the MASTUREPURE® DNA Purification Kit (Epincentre Technologies, Madison, Wis., Cat. No. MCD85201). Briefly, clotted blood (approximately 1 mL) was mixed with an equal volume (1 mL) of 2× Tissue and Cell Lysis Solution, votexed for 10s and combined with 2 mL Tissue and Cell Lysis Solution (MASTUREPURE® kit) containing 25 ng/μL proteinase K. 2 mL of MPC Protein Precipitation Reagent was added to the total volume (4 mL) of the lysed sample and vortex vigorously for 10-15 sec, after which samples were cooled on ice for 1 hour. Cell debris were then pelleted by centrifugation (×2) for at least 30 min at 2000 g and supernatants transferred to a new 50 mL conical tube. DNA was precipitated in 2 volumes of isoproponal, purified by phenol/chloroform extraction and resuspended in 504 DNAse/RNAse free water.

Target DNA Preparation for Microarray Analysis: Genomic DNA samples (3 μg) were digested for 2 hours at 37° C. with 50 U HpaII (New England Biolabs [NEB]) in 904 total reaction volume using NEB buffer 4. A second aliquot of 50 U, 1 μL of buffer 4, and 4 μL water were added and digestion continued overnight (total reaction volume was 100 μL). Mock digestion controls were included to monitor digestion efficiency. Following overnight digestion, reactions were digested further with 5 uL (50 U) of TspRI (NEB) at 65° C. for three hours. Reactions were then incubated further with 75 U (0.75 μl) Exonuclease III (NEB) and incubated at 30° C. for 1 hour. Enzymatic activity was then nullified by heating at 70° C. for 20 min after which 50 U of RecJF (NEB) were added to remove single stranded DNA. Reactions were incubated for 30 min at 37° C. and inactivated at 65° C. for 20 min. Reactions were then phenol-chloroform extracted and the DNA precipitated and resuspended in 21.2 μL nuclease-free de-ionized water. Finally, extracted genomic DNA was quantified and assessed for purity using a NanoDrop ND-1000 UV-VIS Spectrophotometer.

CGH Target Labeling and Hybridization: Experimental and reference DNA were labeled with Cy3-dUTP and Cy5-dUTP respectively, and vice versa for dye-swaps, using a BioPrime CGH Genomic Labeling kit per the manufacturer's protocol (Agilent). Hybridization was performed in a mix containing 50 μL of human Cot-1, 52 μL of Agilent 10× blocking agent, 260 μL of Agilent 2×HiRPM hybridization buffer, and 158 μL of the labeled DNA. The hybridization mix was heated to 95° C. for 3 minutes, then incubated at 37° C. for 30 minutes and applied onto the active array area. Hybridization with gentle agitation was carried out at 65° C. for 40 hours. After hybridization, the slides were washed in Oligo aCGH Wash Buffer 1 and Oligo aCGH Wash Buffer 2, followed by acetonitrile and Stabilization and Drying Solution (Agilent) per the manufacturer's protocol. The slides were scanned using an Agilent Scanner and the data was analyzed using Agilent Feature Extraction software 8.1 (Agilent). Visualization and comparison of the datasets were done with CGH-Analytics 3.2 (Agilent).

Pyrosequencing: 500 ng of each MBC and CVS sample was bisulfite converted using the EZ DNA® Methylation Kit (Zymo Research, Orange, Calif.) as per manufacturer's protocol. Each PCR reaction contained 1×AmpliTaq buffer Gold, 2.0 mM MgCl₂, 0.5 mM dNTP, 0.2 μM each primer, 20 ng bisulfite converted DNA, and 1.5 U AmpliTaq Gold in a 504 reaction volume. The PCR primers were purchased from Integrated DNA Technologies, Inc. (Coralville, Iowa), and the reverse primers biotinylated at their 5′ end. PCR cycling conditions were: 95° for 10 min, 47×(95° for 15s, Tm for 30s, 72° for 30s), 72° for 7 min, 4° hold. Pyrosequencing was performed and analyzed on the above-amplified PCR products on a Biotage PSQ 96MA machine as per the manufacturer's protocol (Biotage Co., Uppsala, Sweden). Unless otherwise noted, all reagents and consumables were purchased directly from Biotage. In brief, 404 of a Streptavidin Sepharose bead (GE Healthcare Co.)/binding buffer mixture were combined with 40 μL of each amplified PCR product in a V-well 96 well plate and mixed for ten minutes at maximum speed on a vortex. Each sequencing primer was diluted in annealing buffer and this mixture placed in a well in a PSQ 96 low plate. After mixing, the beads were captured using a vacuum prep tool and then flushed with 70% ethanol, 0.2M NaOH, and wash buffer successively for 15 seconds each. Beads were released into the sequencing primer/annealing buffer solution by turning off the vacuum and placing the probes in this solution. The primers were annealed by heating to 95° for 2 minutes. Based on the sequence to be analyzed, the pyrosequencing cartridge was prepared, the plate loaded into the machine, and the pyrosequencing program initiated.

Sequenom Epityper Analysis: PCR reactions were carried out in a 384 well format as follows. To each reaction was added 1.42 μL ddH₂O, 0.5 μL 10× Hot Star Buffer (Qiagen) (15 mM MgCl₂, Tris-C1, KCl, (NH₄)₂SO4, pH 8.7), 0.04 μL dNTP mix (25 mM each), 5 U/μL Hot Star Taq (Qiagen). Primers were then added to a final concentration (each) of 1 μM and 1 μL bisulphite converted DNA (1 ng/μL per reaction). Reactions were incubated as follows: 94° C. for 15 minutes then 45 cycles of 94° C. for 20 seconds, 56° C. for 30 seconds (temperature adjusted according to primer Tm), 72° C. for 1 minute followed by 72° C. for 3 minutes. Reactions were then treated with Shrimp alkaline phosphatase (SAP), in vitro transcribed and analyzed according to the manufacturer's instructions (Sequenom). Fully methylated DNA controls were obtained from Millipore-(CpGenome™ Universal Methylated DNA, part number S7821).

Statistical Methods: Each custom Agilent array was hybridized with an HpaII digested sample (HpaII+) against the same sample without HpaII digestion (HpaII−). This HpaII+/− hybridization is designed to detect hypomethylated MspI recognition sites. If the CpG dinucleotide in an MspI site recognition site is hypomethylated, the DNA segments containing this site will be digested by HpaII; thus the signal from the HpaII− sample should be stronger than the signal from the corresponding HpaII+ sample, which will be selectively digested by HpaII. In other words, the log signal ratio of HpaII− to HpaII+ should be positive. Based on this design, the MspI sites can be identified, where the CVS samples and the MBC samples have different methylation patterns in the following way:

First, MspI sites were identified that are hypomethylated in either the CVS samples or the MBC samples, but not in both. It can be tested if an MspI site is hypomethylated in a type of tissue by testing the log signal ratios of the probe targeting that site. If the log signal ratio of HpaII− to HpaII+ is significantly above 0, the MspI site is hypomethylated. Next, MspI sites were identified that were differentially methylated between CVS and MBC. This is done by testing if the log ratio of HpaII+/HpaII− for a probe is the same in both CVS and MBC. If the log ratio is significantly different, the MspI site is differentially methylated. The intersection of the two sets of MspI sites identified in the two previous steps is the set of MspI sets with tissue specific methylation patterns.

The statistical tests used were based on the empirical Bayesian method described in Smyth (Smyth, Sat. Appl. Genet. Mol. Biol. 3: Article 3, 2004), with false discovery rate (FDR) controlled at 5%. The data (green/red signal ratios) are normalized using the cyclic loss method (Bolstad et al., Bioinformatics 19: 185-193, 2003). All analyses were performed using the statistical computing package R.

Example 2 Detection of Methylated Sequences and Results

In order to generate a target library of DNA fragments that are enriched for methylated DNA sequences, an approach was used that takes advantage of the inability of HpaII, an isoschizomer of MspI, to cleave its CCGG recognition sequence when the central CpG dinucleotide of that core site is methylated (Shann et al., Gen. Res. 18: 791-801, 2008). Pre-digestion of the sample DNA with TspRI generates a 9 bp overhang that renders the sample resistant to digestion by exonuclease III. However, exonuclease III is able to digest HpaII-generated 2 bp overhangs and so fragments that are unmethylated at HpaII (MspI) sites and therefore cleaved by this enzyme are lost from the fragment library after digestion with exonuclease III. Sham-digestion of a control library without HpaII provides a comparative analysis between HpaII-digested and sham-digested libraries for the high-throughput determination of DNA methylation status. This procedure is summarized in FIG. 1.

A custom microarray was designed such that every MspI site on chromosomes 13, 18 and 21 is represented by two flanking 60 bp oligonucleotide probes. Each array contains 215,060 informative probes. Among them, 78,548 probes target 42,978 MspI/HpaII sites in chr18, with 35,570 sites targeted by a matching pair of probes. Also, 46,675 probes target 25,878 MspUHpaII sites in chr21, with 20,797 sites targeted by a matching pair of probes. Furthermore, 89,837 probes target 49285 MspUHpaII sites in chr13, with 40,552 sites targeted by a matching pair of probes. The complete array design is provided in Supplementary File F1 of Chu et al., “A microarray based approach for the identification of epigentic biomarkers for the non-invasive diagnosis of fetal disease,” Prenatal Diagnosis 29: 1020-1030, 2009, published on-line Jul. 31, 2009; the manuscript and the on-line supplementary information is incorporated by reference herein.

Each member of a probe pair matches one flanking sequence of an MspI recognition site whilst the other member of the pair matches the opposite flanking sequence. Thus two non-overlapping probes are present for every MspI site. To minimize false positive and negative results a pooling strategy was adopted for DNA samples prior to target library preparation in which two pools each of CVS and MBC were used, where each pool contained samples from four individuals respectively. technical replicate experiments were also carried out using a dye-swapping approach.

Using this approach, 6,311 MspI/HpaII sites were identified across all three chromosomes that were differentially methylated between CVS and MBCs and reached statistical significance under the criteria described in Materials and Methods. These included 1,272 sites on chromosome 21; 2,297 on chromosome 18; and 2,742 on chromosome 13 respectively. These can be considered to be tissue specific differentially methylated CpG sites (T-DMRs). Of these differentially methylated sites, 5,499 are hypomethylated in CVS versus MBC whereas only 812 are hypomethylated in MBC versus CVS. The entire list of T-DMRs is provided in Table S1 of Chu et al., “A microarray based approach for the identification of epigentic biomarkers for the non-invasive diagnosis of fetal disease,” Prenatal Diagnosis 29: 1020-1030, 2009, published on-line Jul. 31, 2009; the manuscript and the on-line supplementary information is incorporated by reference herein.

Given that the diagnostic utility of methylation-specific quantitative analysis of fetal DNA requires that the target amplicon include a polymorphic marker for which the fetus is heterozygous (Tong et al., 2006), the data was analyzed for significant T-DMRs that are located within 150 bp of a known SNP. This is because the most attractive candidate T-DMRs will be adjacent to SNPs that are highly polymorphic and therefore common amongst target patient populations (Tong et al., 2006). Of the CpG sites hypomethylated in CVS relative to MBC, 888, 755 and 482 on chromosomes 13, 18 and 21 respectively, were found to be within 150 bp of a polymorphic SNP using a heterozygosity cut-off of 0.25. Similarly, of the CpG sites hypomethylated in MBC relative to CVS, 151, 115 and 107 were found to be within 150 bp of a polymorphic SNP using a heterozygosity cut-off of 0.25. The top 15 T-DMRs within 150 bp of a polymorphic SNP are shown in Table 1 and the full list, ranked by statistical significance, in Tables S2-1 through S2-6 of Chu et al., “A microarray based approach for the identification of epigentic biomarkers for the non-invasive diagnosis of fetal disease,” Prenatal Diagnosis 29: 1020-1030, 2009, published on-line Jul. 31, 2009; the manuscript and the on-line supplementary information is incorporated by reference herein.

TABLE 1 T-DMRs within 150 bp of a polymorphic SNP determined by custom Agilent microarray analysis for chromosomes 21 (A and B), 18 (C and D) and 13 (E and F). Probe SNP rs.id Combined pval Unique ID Probe Position A. Hypomethylated in MBC Versus CVS on Chromosome 21 11702354 2.01E−13 202853 chr21: 34806349-34806290 11702354 2.01E−13 13099 chr21: 34806348-34806407 11702450 3.30E−12 15805 chr21: 46528161-46528220 11702450 3.30E−12 107388 chr21: 46528162-46528103 2839418 4.57E−11 88603 chr21: 42192976-42193035 2839418 4.57E−11 172376 chr21: 42192977-42192918 6517531 2.35E−10 172933 chr21: 39559604-39559545 6517531 2.35E−10 172764 chr21: 39559603-39559662 2824493 9.08E−10 130381 chr21: 18087813-18087872 2824493 9.08E−10 115667 chr21: 18087814-18087755 2835676 1.67E−09 195931 chr21: 37513226-37513285 2835676 1.67E−09 74314 chr21: 37513227-37513168 2823026 2.50E−09 170571 chr21: 15346480-15346539 2823026 2.50E−09 125765 chr21: 15346481-15346422 6517254 5.09E−09 120612 chr21: 35002142-35002201 6517254 5.09E−09 105469 chr21: 35002143-35002084 2070368 5.09E−09 105469 chr21: 35002143-35002084 2070368 5.09E−09 120612 chr21: 35002142-35002201 220269 5.55E−09 212124 chr21: 42357349-42357290 220269 5.55E−09 165397 chr21: 42357348-42357407 B. Hypomethylated in CVS Versus MBC on Chromosome 21 225395 1.33E−14 31538 chr21: 42559967-42560026 225395 1.33E−14 115974 chr21: 42559968-42559909 2837528 2.52E−14 136995 chr21: 40533598-40533539 2837528 2.52E−14 1216 chr21: 40533597-40533656 2827557 1.33E−13 12999 chr21: 22839640-22839581 2827557 1.33E−13 178006 chr21: 22839639-22839698 2822564 9.55E−13 188482 chr21: 14608183-14608242 2822564 9.55E−13 73052 chr21: 14608184-14608125 233895 2.13E−12 85116 chr21: 27247103-27247162 233895 2.13E−12 11559 chr21: 27247104-27247045 9980448 3.89E−12 193547 chr21: 42712730-42712789 9980448 3.89E−12 58155 chr21: 42712731-42712672 2827384 3.07E−11 97870 chr21: 22605322-22605263 2827384 3.07E−11 120832 chr21: 22605321-22605380 2826052 6.62E−11 14852 chr21: 20457190-20457249 2826052 6.62E−11 2381 chr21: 20457191-20457132 9977149 1.02E−10 30513 chr21: 15936203-15936144 9977149 1.02E−10 39772 chr21: 15936202-15936261 3453 1.16E−10 145449 chr21: 34741083-34741024 3453 1.16E−10 142382 chr21: 34741082-34741141 C. Hypomethylated in MBC Versus CVS on Chromosome 18 8083921 6.01E−12 90918 chr18: 58916958-58917017 8083921 6.01E−12 189198 chr18: 58916959-58916900 546680 5.81E−11 158354 chr18: 30988045-30988104 546680 5.81E−11 76298 chr18: 30988046-30987987 4891159 1.53E−10 48439 chr18: 72230922-72230863 4891159 1.53E−10 89527 chr18: 72230921-72230980 16978450 4.22E−10 211790 chr18: 41517172-41517231 3786395 4.22E−10 211790 chr18: 41517172-41517231 7245283 4.32E−10 174750 chr18: 957430-957371 7245283 4.32E−10 169527 chr18: 957429-957488 9945379 4.47E−10 57634 chr18: 10928196-10928255 9945379 4.47E−10 52550 chr18: 10928197-10928138 12958513 1.06E−09 28434 chr18: 41520963-41521022 16978452 1.06E−09 28434 chr18: 41520963-41521022 7228161 1.06E−09 28434 chr18: 41520963-41521022 16978452 1.06E−09 41831 chr18: 41520964-41520905 12958513 1.06E−09 41831 chr18: 41520964-41520905 7228161 1.06E−09 41831 chr18: 41520964-41520905 11875350 1.57E−09 50589 chr18: 66307845-66307786 11152348 2.01E−09 118255 chr18: 58349522-58349463 D. Hypomethylated in CVS Versus MBC on Chromosome 18 12955286 2.23E−14 197827 chr18: 39459451-39459510 1852531 2.23E−14 197827 chr18: 39459451-39459510 1852531 2.23E−14 111977 chr18: 39459452-39459393 12955286 2.23E−14 111977 chr18: 39459452-39459393 1244833 1.58E−13 206906 chr18: 67161475-67161534 1244833 1.58E−13 100157 Chr18: 67161476-67161417 2923220 3.66E−13 98530 Chr18: 67061707-67061648 2923220 3.66E−13 114767 Chr18: 67061706-67061765 16977803 7.31E−13 15847 Chr18: 39904531-39904590 16977803 7.31E−13 13551 Chr18: 39904532-39904473 603884 7.62E−13 6351 Chr18: 50016366-50016425 603884 7.62E−13 155051 Chr18: 50016367-50016308 4800573 8.57E−13 40020 Chr18: 20313668-20313609 4800573 8.57E−13 165509 Chr18: 20313667-20313726 12970409 9.62E−13 107335 Chr18: 23756169-23756228 12970409 9.62E−13 97494 Chr18: 23756170-23756111 11663168 1.10E−12 173600 chr18: 910151-910092 11663172 1.10E−12 173600 chr18: 910151-910092 11663172 1.10E−12 174485 chr18: 910150-910209 11663168 1.10E−12 174485 chr18: 910150-910209 E. Hypomethylated in MBC Versus CVS on Chromosome 13 7317471 6.71E−13 10348 Chr13: 20518120-20518061 7317471 6.71E−13 44374 Chr13: 20518119-20518178 3742160 5.09E−12 200018 chr13: 105943751-105943810 3742160 5.09E−12 153614 chr13: 105943752-105943693 206321 1.75E−11 94618 Chr13: 31888677-31888736 206321 1.75E−11 2447 Chr13: 31888678-31888619 9579199 2.41E−11 70801 Chr13: 28062767-28062708 9578047 2.41E−11 70801 Chr13: 28062767-28062708 9578047 2.41E−11 202671 Chr13: 28062766-28062825 9579199 2.41E−11 202671 Chr13: 28062766-28062825 9506534 2.82E−11 173211 Chr13: 20145259-20145318 9506534 2.82E−11 72382 chr13: 20145260-20145201 1411551 8.55E−11 49844 chr13: 109170896-109170837 1411551 8.55E−11 49787 chr13: 109170895-109170954 4772302 1.50E−10 77302 chr13: 99968298-99968239 9515119 5.74E−10 73274 chr13: 109207221-109207162 9515119 5.74E−10 197654 chr13: 109207220-109207279 9551454 1.09E−09 201286 chr13: 27730895-27730954 9551454 1.09E−09 214291 chr13: 27730896-27730837 17593586 2.72E−09 121914 chr13: 40694042-40693983 F. Hypomethylated in CVS Versus MBC on Chromosome 13 9542537 2.39E−13 16916 chr13: 70392637-70392696 9542537 2.39E−13 193406 chr13: 70392638-70392579 7983181 3.47E−13 118841 chr13: 82628956-82628897 7983181 3.47E−13 113031 chr13: 82628955-82629014 166710 5.70E−13 2591 chr13: 35186503-35186562 166710 5.70E−13 103271 chr13: 35186504-35186445 9301803 6.28E−13 90142 chr13: 91837064-91837005 9301804 6.28E−13 46449 chr13: 9837063-91837122 9301804 6.28E−13 90142 chr13: 91837064-91837005 9301803 6.28E−13 46449 chr13: 91837063-91837122 2025675 1.06E−12 158650 chr13: 70621925-70621984 2025675 1.06E−12 40595 chr13: 70621926-70621867 11617606 2.44E−12 24847 chr13: 109322585-109322526 11617606 2.44E−12 156269 chr13: 109322584-109322643 9535813 3.74E−12 62282 chr13: 51453087-51453146 9316563 3.74E−12 18480 chr13: 51453088-51453029 9316563 3.74E−12 62282 chr13: 51453087-51453146 9535813 3.74E−12 18480 chr13: 51453088-51453029 980094 4.48E−12 156466 chr13: 94960749-94960808 2389355 4.48E−12 19072 chr13: 94960750-94960691 To confirm the accuracy of the microarray data, the differential methylation of a number of MspI sites was confirmed by pyrosequencing (FIG. 2A) and Mass Array/Epityper (FIG. 2B). Notably, a number of these sites are flanked by additional CpGs that are also differentially methylated, as indicated in FIG. 2B. Furthermore, of 14 CpG islands previously suggested to be good candidates for development as biomarkers for fetal aneuploidies on chromosome 21 (Chim et al., Clin. Chem. 54: 500-511, 2008), 70% are found in genes that we identified in our data as containing T-DMRs (Table 2).

TABLE 2 Comparison between previously identified chromosome 21 T-DMRs (Chim et al., supra, 2008) and current data Gene Previously T-DMR Identified by Identified as T-DMR Current Study (Chim et al., 2008) (probe unique ID) Methylated in CVS C21orf63 Yes (30351) and unmethylated in OLIG2 No MBC CBR1 No SIM2 Yes (72327) DSCAM Yes (88779) TRPM2 Yes (149601) C21orf29 Yes (19822) COL18A1 Yes (29860) Unmethylated in CVS, RUNX1 Yes (32873) methylated in MBC PDE9A Yes (49044) HIST1H2BK No HSF2BP Yes (98506) COL6A1 Yes (107986) COL6A2 Yes (135238)

In this study, the first trimester placental DNA methylome at its maternal interface was evaluated to identify potential biomarkers for the minimally-invasive diagnosis of fetal genetic disease. Differentially methylated MspI recognition sequences (CCGG) on human chromosome 13, 18 and 21 were identified using DNA extracted from CVS compared to DNA from maternal leukocyte samples. This was achieved using a custom microarray designed for this purpose and novel computational and statistical methods.

Thus, a comprehensive analysis of DNA methylation differences between genomic DNA isolated from first trimester human placental samples at their maternal interface and gestational age -matched MBC samples was performed. These data provided candidate markers for further development in the context of fetal genetic diagnosis. These biomarkers are of use, as they exhibited differential methylation between CVS and MBCs and were found with 150 bp of highly polymorphic SNPs.

It was first demonstrated in 1997 that Y chromosome DNA derived from a male fetus can be detected by PCR in maternal plasma and serum (Lo et al., Am. J. Hum. Genet. 62: 768-775, 1998b). This minimally invasive approach requires only a maternal blood sample. Fetal DNA constitutes approximately 3-10% of total maternal plasma DNA and it has been shown that this frequency is increased both in aneuploid and preeclamptic pregnancies when compared to those that progress nominally (Lo et al., Clin. Chem. 45: 1747-51, 1999a, Lo et al., Clin. Chem. 45: 184-188, 1999b, Lun et al., Clin. Chem. 45: 1664-1672, 2008). Methods for the detection of specific sex-linked fetal DNA mutations (Costa et al., N. Engl. J. Med. 346: 1502, 2002) and paternally inherited Beta-thalassemia and achrondroplasia have been published (Li et al., JAMA 293: 843-849, 2005, Li et al., Prenat. Diagnosis 27: 11-172007) and a plasma-based DNA test to predict fetal Rhesus D blood group status is now widely used in clinical practice (Lo et al., NEJM 339: 1734-1738, 1998a).

Recently, differences in the methylation status of the RASSF1 and Maspin genes in the DNA of placental tissue and maternal hematopoetic cells have been exploited via methylation-specific PCR to selectively amplify fetal DNA sequences on chromosomes 3 and 18 respectively from maternal blood (Chim et al., PNAS 102: 14753-8, 2005, Chan et al., Clin. Chem. 52: 2211-2218, 2006). This approach has been shown to have diagnostic potential in the context of fetal disease in that elevated placental RASSF1 levels in maternal plasma have been shown in early pregnancy to be associated with an eventual diagnosis of preeclampsia (Tsui et al., Prenat. Diagn. 27: 1212-1218, 2007b) and Maspin may have potential for the detection of a subset of cases of trisomy 18 (Tong et al., Clin. Chem. 52: 2194-2202, 2006). One limitation to progression in this field, however, is the lack of comprehensive information relating to CpG sites that are differentially methylated between CVS and MBC (see Chim et al., Clin Chem. 54: 500-11, 2008). Provided herein is a comprehensive list of T-DMRs that exist between CVS and MBC on chromosomes with diagnostic significance in the context of fetal aneuploidy. Furthermore, within this context, sequences have been identified that detect aneuploidy in a fetus. These sequences are provided herein.

Example 3 Detection of Fetal Aneuploidy

Recruitment of Pregnant Individuals During Early Gestation: Patients who are >35 years of age or have a family history of birth defects or genetic conditions are referred for genetic counseling as a matter of routine. During this consult they are generally offered amniocentesis or CVS depending on gestational age and preference. Regardless of whether they elect to undergo an invasive diagnostic procedure, the vast majority of these individuals receive a first trimester serum screen and an ultrasound for nuchal translucency. Patients who are <35 years of age and have no family history of birth defects or genetic conditions are not routinely scheduled for genetic counseling. Instead they undergo a first trimester serum screen and a nuchal translucency test. If the patient has an increased risk result, she is contacted by a genetic counselor and is offered a consult and diagnostic testing via amniocentesis or CVS. All study participants are drawn from the population of individuals undergoing informed consent and patient recruitment will take place in the Center for Medical Genetics. Should individuals who are consented elect not to undergo either CVS or amniocentesis, these deliveries are tracked through the GIS database (above) to obtain post-natal outcome data.

Data and Sample Tracking: Each participant entering into the study is assigned a unique bar code, to be issued at the time of consent. This bar code is used to track the patient's blood sample, plasma-derived DNA, sequencing library and the resulting data and is linked to all available clinical and demographic information including diagnostic test results and birth outcome.

Separation of plasma from whole blood: Whole blood is centrifuged at 1600×g for 13 min at 4° C., setting acceleration and deceleration to 3. 1 ml aliquots of plasma are pipetted into 1.5 ml centrifuge tubes. Cellular debris is pelleted by centrifuging the plasma at 16000×g for 10 min at 4° C. 900 ul from each tube is pipetted into a clean 1.5 ml tube. Plasma aliquots are stored at −80° C.

DNA extraction from plasma: DNA is extracted from plasma using the QIAMP® DNA mini kit (Qiagen) and supplied reagents. Briefly, 1 vial of frozen plasma is thawed to room temperature and split into two tubes. 40 ul of Qiagen Protease is added to each tube and the sample inverted 5 times to mix. 400 ul buffer AL is added to each tube and the sample vortexed for 15 sec. Samples are incubated at 56° C. for 10 min. 400 ul 100% ethanol is added to each tube and tubes are vortexed for 15 sec. 600 ul of mixture is applied to the spin column and centrifuged at 6000×g for 1 min, repeating this step as many times as necessary to get the entire plasma sample through the same column. The column is washed by adding 500 ul buffer AW and centrifuging for 1 min at 6000×g. The column is then washed again by adding 500 ul buffer AW2, and centrifuging for 4 min at maximum speed. To remove residual ethanol, the column is placed in a clean collection tube and centrifuged at maximum speed for 2 min. To elute the DNA, the column is placed in a 1.5 ml tube, 75 ul of RNase/DNase free water is added to the column, the column is incubated at room temp for 5 minutes and then centrifuged for 1 min at 6000×g.

HpaII Digestion for Selection of Methylated DNA Loci: DNA is combined with 4 ul 10× Fast Digestion Green buffer and 0.5 ul Fast Digest HpaII (Fermentas, Glen Burnie, MD) in a 40 ul reaction volume and incubated at 37° C. for 5 min. An additional 0.5 ul Fast Digest HpaII is added and the mixture is incubated for another 5 min at 37 degrees. The reaction is then incubated at 70° C. for 5 minutes to heat inactivate the enzyme. For each sample, a mock digestion in which no HpaII was added is run simultaneously. Samples are then purified using Qiagen's MINELUTE® Reaction Clean-up Kit (Qiagen, Valencia, Calif.) as per the manufacturer's protocol. Each sample is combined with 300 ul buffer ERC, applied to a spin column and centrifuged at maximum speed for 1 min. The column is washed with 750 ul buffer PE and then transferred to a 1.5 ml tube. DNA is eluted by adding 10 ul water to the center of the spin column, incubating for 1 minute at room temperature and centrifuging at maximum speed for 1 min), see FIG. 3.

Bisulphite Treatment of DNA: DNA can be bisulfite converted using the EZ DNA® Methylation Kit (Zymo Research, Irvine, Calif.) as per manufacturer's protocol. Briefly, 500 ng DNA is combined with 5 ul M-Dilution buffer in a total reaction volume of 50 ul and incubated at 37 degrees for 15 min. 100 ul of the CT Conversion Reagent is added and the mixture incubated at 50 degrees for 16 hr. After incubating on ice for 10 min, the sample is combined with 400 ul M-Binding Buffer in a spin column. The column is inverted several times to mix and then centrifuged at maximum speed for 30 sec. After washing the column with 100 ul M-Wash Buffer, 200 ul M-desulphonation buffer is added to the column and incubated at room temperature for 20 min. The column is centrifuged at maximum speed for 30 sec and then washed twice with 200 ul M-Wash Buffer. After transferring the column to a 1.5 ml tube, the DNA is eluted by adding 10 ul M-Elution Buffer and centrifuging at maximum speed for 30 sec.

MBD2 protein Mediated Enrichment of methylated DNA: Enrichment of DNA by methylation status is performed using the METHYLMINER® Methylated DNA Enrichment Kit (Invitrogen, Carlsbad, Calif.) as per manufacturer's protocol. Briefly, 10 ul of DYNABEADS® M-280 Streptavidin beads is washed with 90 ul binding/wash buffer and then resuspended in 100 ul binding/wash buffer. 3.5 ug of MBD-Biotin Protein in 100 ul binding/wash buffer is combined with the beads, and the mixture is incubated at room temperature for 1 hr on a rotating mixer. The beads are washed three times in wash/binding buffer and then resuspended in 100 ul binding/wash buffer. Up to 1 ug fragmented DNA in 100 ul binding/wash buffer is combined with the beads, and this mixture is incubated on a rotating mixer for 1 hour at room temperature. The beads are collected against the side of the tube by a magnet and the supernatants removed. This fraction contains the non-methylated DNA. The beads are washed twice with 200 ul bind/wash buffer. The beads then are incubated in 200 ul 2M NaCl on a rotating mixer for 3 min at room temperature, collected against the side of the tube by a magnet and the supernatant containing the methylated DNA pipetted into a clean tube. The beads are incubated with an additional 200 ul 2M NaCl to ensure total collection of the methylated DNA. DNA is then purified and concentrated by ethanol precipitation and resuspended in water.

Enzymatic Enrichment of Methylated DNA Using TspRI and Exonuclease This method can be used prior to a gene/locus specific amplification or other enrichment step. This method selectively isolates methylated DNA fragments from a complex DNA sample. It is highly effective in this regard and can be used prior to simple amplification/enrichment and subsequent copy number analysis. Genomic DNA samples (3 μg) are digested for 2 hours at 37° C. with 50 U HpaII (New England Biolabs) in 904 total reaction volume using NEB buffer 4. A second aliquot of 50 U, 1 μL of buffer 4, and 44 water is added and digestion continued overnight (total reaction volume was 1004). Mock digestion controls are included to monitor digestion efficiency. Following overnight digestion, reactions are digested further with 5 uL (50 U) of TspRI (NEB) at 65° C. for three hours. Reactions are then incubated further with 75 U (0.75 μl) Exonuclease III (NEB) and incubated at 30° C. for 1 hour. Enzymatic activity is then nullified by heating at 70° C. for 20 min after which 50 U of RecJF (NEB) are added to remove single stranded DNA. Reactions are incubated for 30 min at 37° C. and inactivated at 65° C. for 20 min. Reactions are then phenol-chloroform extracted and the DNA precipitated and resuspended in 21.24 nuclease-free de-ionized water. Finally, extracted genomic DNA is quantified and assessed for purity using a NanoDrop ND-1000 UV-VIS Spectrophotometer.

Illumina DNA Sequencing Sample/DNA Library Preparation: Plasma is separated from whole blood following centrifugation at 1,600×g for 10 minutes, followed by a second centrifugation to remove contaminating nucleated cells at 16,000×g for 10 minutes. DNA is extracted from plasma using the QIAAMP® DNA Blood Mini kit (Qiagen) and an Illumina sequencing library prepared as follows. The following oligos 5′—ACA CTC TTT CCC TAC ACG ACG CTC TTC CGA TC*T—3′ (SEQ ID NO: 69) and 5′-/5Phos/GAT CGG AAG AGC TCG TAT GCC GTC TTC TGC TTG—3′ (SEQ ID NO: 70) are resuspended in TE and annealed in 1×T4 DNA Ligase Reaction Buffer (NEW ENGLAND BIOLABS®, NEB) by heating at 95° C. for 5 minutes and then slowly cooled to room temperature for a final concentration of 36 mM annealed adaptor. Plasma DNA fragments is end repaired and then terminal A-residues added using the NEBNext End Repair and the NEBNext dA-tailing modules as per manufacturer's protocols (NEB). Following reaction cleanup using the MINELUTE® Cleanup kit (Qiagen), DNA fragments is combined with 0.5 uM adaptor and 400 U T4 DNA ligase (NEB) and incubated for 2 hours at 16° C. After reaction cleanup with MINELUTE® Cleanup kit, PCR is performed using the following primers: 5′—CAA GCA GAA GAC GGC ATA CGA GCT CTT CCG ATC*T—3′ (SEQ ID NO: 71) and 5′—AAT GAT ACG GCG ACC ACC GAG ATC TAC ACT CTT TCC CTA CAC GAC GCT CTT CCG ATC*T—3′ (SEQ ID NO: 72) and Phusion High-Fidelity DNA Polymerase (NEB). PCR conditions will include an initial denaturation (98° C. 30s), 12 cycles of 98° C. for 10s, 65° C. for 30s and 72° C. for 30s, with a final extension of 72° C. for 7 min. Following amplification, the PCR reaction is cleaned up using the MINELUTE® PCR Purification Kit (Qiagen).

Illumina DNA Sequencing Sample/DNA Library Preparation: Plasma is separated from whole blood following centrifugation at 1,600×g for 10 minutes, followed by a second centrifugation to remove contaminating nucleated cells at 16,000×g for 10 minutes. DNA is extracted from plasma using the QIAAMP® DNA Blood Mini kit (Qiagen) and an Illumina sequencing library prepared as follows. The following oligos 5′—ACA CTC TTT CCC TAC ACG ACG CTC TTC CGA TC*T—3′ (SEQ ID NO: 73) and 5′-/5Phos/GAT CGG AAG AGC TCG TAT GCC GTC TTC TGC TTG—3′ (SEQ ID NO: 74) are resuspended in TE and annealed in 1×T4 DNA Ligase Reaction Buffer (NEB) by heating at 95° C. for 5 minutes and then slowly cooled to room temperature for a final concentration of 36 mM annealed adaptor. Plasma DNA fragments is end repaired and then terminal A-residues added using the NEB NEXT END REPAIR® and the NEBNEXT® dA-tailing modules as per manufacturer's protocols (NEB). Following reaction cleanup using the MINELUTE® Cleanup kit (Qiagen), DNA fragments are combined with 0.5 uM adaptor and 400 U T4 DNA ligase (NEB) and incubated for 2 hours at 16° C. After reaction cleanup with MINELUTE® Cleanup kit, PCR is performed using the following primers: 5′—CAA GCA GAA GAC GGC ATA CGA GCT CTT CCG ATC*T—3′ (SEQ ID NO: 75) and 5′—AAT GAT ACG GCG ACC ACC GAG ATC TAC ACT CTT TCC CTA CAC GAC GCT CTT CCG ATC*T—3′ (SEQ ID NO: 76) and PHUSION® High-Fidelity DNA Polymerase (NEB). PCR conditions include an initial denaturation (98° C. 30s), 12 cycles of 98° C. for 10s, 65° C. for 30s and 72° C. for 30s, with a final extension of 72° C. for 7 min. Following amplification, the PCR reaction is cleaned up using the MINELUTE® PCR Purification Kit (Qiagen).

Pyrosequencing: Specific details of Pyrosequencing analysis vary depending on the context of the desired analysis. Examples \ of pyrosequencing based methods that are appropriate for digital analysis of locus-specific DNA copy number are provided below.

Library Preparation: Prior to the following steps, a variety of methods can be utilized to generate targeted fetal DNA fragments on chromosomes of interest. Fragments are then processed as follows. Fragment ends are polished by incubation in polishing reaction (1× Polishing Buffer, dNTP's, ATP, polynucleotide kinase and T4 DNA polymerase) at 12° C. for 15 minutes and 25° C. for 15 minutes. Polished fragments are cleaned via a second MINELUTE® PCR purification column. Adapters ‘A’ and ‘B’ are ligated to the polished DNA fragments by incubation at 25° C. for 15 minutes. Ligation reaction is purified via MINELUTE® PCR purification column. DNA fragments with 2 ‘A’ or 2 ‘B’ adapters are removed using streptavidin coated library immobilization beads. ‘B’ adapters are biotinylated and thus adhere to the coated beads, while ‘A’ adapters do not. Fragments with ‘A’ adapters on both ends are washed away with BEAD WASH® buffer. Following bead washing DNA is denatured and the single unbound strand of ‘A’ adapter and ‘B’ complement is retained for future processing. Strands with ‘B’ adapters on both ends do not have an unbound strand and so are left on the beads at this point. A 1 ml aliquot of final single stranded product is run on a bioanalyzer RNA 6000 pico chip to assess size distribution and concentration.

emPCR: sstDNA fragments are bound to library capture beads by mixing sample library with capture beads and performing the following thermocycler program: 80° C. for 5 minutes, ramp 0.1° C./sec to 70° C., hold at 70° C. for 1 minute, ramp 0.1° C./sec to 60° C., hold at 60° C. for 1 minutes, ramp 0.1° C./sec to 50° C. hold at 50° C. for 1 minute, ramp 0.1° C./sec to 20° C. Emulsion of PCR reagents in microreactors with library capture beads is prepared by mixing beads, PCR reaction mix (1× amplification mix, amplification primers, 0.15 U/ml PLATINUM TAQ® (Invitrogen)), and emulsion oil and mixing vigorously using a TISSUE LYSER® (Qiagen). Emulsion is distributed into a PCR plate and template amplification is carried out in a thermocycler using the following cycling conditions: Hotstart activation for 4 minutes at 94° C., 40 cycles of 94° C. for 30 seconds, 58° C. for 1 minute, 68° C. for 90 seconds followed by 13 cycles of 94° C. for 30 seconds and 58° C. for 6 minutes. Following template amplification, emulsions are broken and beads with amplified product recovered by repeated washes with ethanol using a syringe filter unit.

Bead Enrichment: Enrichment beads are added to the recovered amplification beads. Enrichment beads are coated with oligos complementary to the free end of the amplified template. Successful amplification beads become bound to the paramagnetic enrichment beads and are drawn out of solution using a magnetic rack. Unsuccessful amplification beads are drawn off with the supernatant and discaraded. The bond between the amplification and enrichment beads is broken using 125 mM NaOH. Enrichment beads are pelleted using a magnetic rack and the enriched amplification beads are recovered. Melt solution is neutralized by repeated washes with 1× Annealing buffer and the beads left suspended in annealing buffer.

Sequencing primers are added to the mixture of beads and annealing buffer and annealed to the template using the following thermocycler conditions: 65° C. for 5 minutes, ramp to 50° C. at 0.1° C./second, hold at 50° C. for 1 minute, ramp to 40° C. at 0.1° C./second, hold at 40° C. for 1 minute, ramp to 15° C. at 0.1° C./second, hold 15° C. Beads are counted using a Beckman Z1 particle counter.

PICOTITERPLATE® Preparation: Based on bead count obtained above and manufacturer recommendations for the PICOTITERPLATE® region size being used, control beads and sample beads are mixed to form the sequencing sample. Packing beads, sample beads and enzyme beads are applied to the PICOTITERPLATE® as per manufacturer instructions.

Sequencing Reaction: The PICOTITERPLATE® is loaded onto the FLX® sequencer and the run started. The FLX® uses pyrosequencing chemistry and detects the incorporation of each nucleotide in real time.

emPCR Titration: For each sample, a preliminary titration run must be performed in order to determine the best ratio of DNA template to amplification beads to obtain a maximum amount of usable sequence from the final data run. The concentration of DNA template is determined in copies/ml by applying the mass of the average fragment size as determined from the bioanalyzer output to the measured concentration of sstDNA library. emPCR reactions corresponding to titration points of 0.5, 2, 4 and 16 copies/bead are performed as described for emPCR above. Emulsions are broken and beads recovered. Amplification beads are not enriched but are counted and loaded onto a pico titer plate for sequencing analysis. The number of beads that can be successfully sequenced is used to determine the optimum ratio of DNA to beads for the final emPCR reaction to produce template for data production.

DNA Copy Number Analysis by Real Time PCR: TAQMAN® Copy Number assays for each target gene as well as the TAQMAN® Copy Number Reference assay may be purchased from Applied Biosystems. For each real time PCR reaction, 10 ul 2× TAQMAN® Genotyping Master Mix, 1 ul 20× TAQMAN® Copy Number assay, 1 ul 20× TAQMAN® Copy Number Reference assay, 20 ng DNA and water are combined for a total reaction volume of 20 ul. Each sample is run in triplicate for quality control. Cycling conditions were 95 degrees for 10 min followed by 40 cycles of 95 degrees for 15 sec and 60 degrees for 1 min. The real time PCR reactions are read and analyzed using COPYCALLER® Software on the 7900HT Sequence Detection System (Applied Biosystems), see FIG. 3.

Tissue Handling and DNA Extraction: DNA can be recovered from placental tissues or blood cells to confirm DNA methylation levels in pure sample. Placental samples are dissected under a microscope and separated from any decidua or flecks of blood. The culture media is removed and the tissue placed in 1.5-2.0 mL microcentrifuge tubes before freezing at −80° C. until DNA is extracted. To extract the DNA, one 5 mm stainless steel bead and 1804 buffer ATL (from Qiagen's DNEASY® Blood and Tissue kit) were added to each CVS sample. The samples are placed in the TISSUELYSER® (Qiagen) Adaptor set 2×24, and the TISSUELYSER® operated for 20 seconds at 30 Hz. The DNA is then purified using the DNEASY® Blood and Tissue kit as per the manufacturer's protocol. MBCs are obtained between gestational weeks 11 and 13. DNA is extracted from the MBC's using a modified protocol previously described by Iovannisci, et al., 2006 (25), using reagents from the MASTUREPURE® DNA Purification Kit (Epincentre Technologies, Madison, Wis., Cat. No. MCD85201). Briefly, clotted blood (approximately 1 mL) is mixed with an equal volume (imp of 2× Tissue and Cell Lysis Solution, votexed for 10s and combined with 2 mL Tissue and Cell Lysis Solution (MASTUREPURE® kit) containing 25 ng/μL proteinase K. 2 mL of MPC Protein Precipitation Reagent is added to the total volume (4 mL) of the lysed sample and vortex vigorously for 10-15 sec, after which samples are cooled on ice for 1 hour. Cell debris are then pelleted by centrifugation (×2) for at least 30 min at 2000 g and supernatants transferred to a new 50 mL conical tube. DNA is precipitated in 2 volumes of isoproponal, purified by phenol/chloroform extraction and resuspended in 50 μL DNAse/RNAse free water.

Quantification of Fetal DNA Frequency Using Real Time PCR: To validate fetal DNA frequency in maternal plasma of samples in a clinical trial, Real Time PCR determination of fetal DNA concentration in maternal plasma is carried according to the method of Maron, et al (Maron, 2007) using the following primers:

SRY: Forward primer {SEQ ID NO: 77) 5′-TCCTCAAAAGAAACCGTGCAT-3′ Reverse primer (SEQ ID NO: 78) 5′-AGATTAATGGTTGCTAAGGACTGGAT-3′ Probe- (SEQ ID NO: 79) 5′-FAM-CACCAGCAGTAACTCCCCACAACCTCTTT-TAMRA-3′ B-globin: Forward primer (SEQ ID NO: 80) 5′-GTGCACCTGACTCCTGAGGAGA-3′ Reverse primer- (SEQ ID NO: 81) 5′-CCTTGATACCAACCTGCCCAG-3′ Probe- (SEQ ID NO: 82) 5′-FAM-AAGGTGAACGTGGATGAAGTTGGTGG-TAMRA-3′

B-globin is an ubiquitous housekeeping gene and is run concurrently with the SRY to ensure that DNA was present for each sample, irrespective of fetal gender. In order to estimate DNA concentration in the plasma DNA, a standard curve is run simultaneously alongside the plasma DNA sample. The standard curve DNA is prepared using commercially available DNA of known concentration. The range of values for the standard curve is approximately 6.4 μg/5 ul to 20,000 μg/5 ul. For each real time PCR reaction, 12.5 ul 2× TAQMAN® Universal PCR Master Mix, 1.25 ul 10 uM forward primer, 1.25 ul 10 uM reverse primer and 0.0625 ul 100 uM probe, 10 ul plasma DNA, 5 ul standards or 10 ul water (to serve as negative control) is added to the appropriate wells. Each plasma DNA sample and the negative control are run in triplicate. The standard curve DNA will also be run in triplicate. The thermal cycling conditions involve an initial denaturation step of 95° C. for 10 minutes, followed by 50 cycles of 95° C. for 15 sec and 60° C. for 1 min. The real time PCR reactions are performed using the 7900HT Sequence Detection System (Applied Biosystems).

Sequenom Epityper Analysis: DNA methylation can be abalyzed in a quantitative fashion using the Mass Array method from SEQUENOM®. This is not suitable for digital chromosome copy number analysis but rather serves as a suitable method for confirming DNA methylation levels in samples of DNA. This method was used to validate results obtained by microarray based discovery (Chu et al., 2009, supra) of differentially methylated fetal versus maternal DNA. PCR reactions are carried out in a 384 well format as follows. To each reaction is added 1.42 μL ddH₂O, 0.54 μL 10× HOT STAR® Buffer (Qiagen) (15 mM MgCl₂, Tris-Cl, KCl, (NH₄)₂SO4, pH 8.7), 0.044 dNTP mix (25 mM each), 5 U/μL HOT STAR® Taq (Qiagen). Primers are then added to a final concentration (each) of 1 μM and 14 bisulphite converted DNA (1 ng/4 per reaction). Reactions are incubated as follows: 94° C. for 15 minutes then 45 cycles of 94° C. for 20 seconds, 56° C. for 30 seconds (temperature adjusted according to primer Tm), 72° C. for 1 minute followed by 72° C. for 3 minutes. Reactions are then treated with Shrimp alkaline phosphatase (SAP), in vitro transcribed and analyzed according to the manufacturer's instructions (Sequenom). Fully methylated DNA controls are obtained from Millipore-(CpGenome Universal Methylated DNA, part number S7821).

It is apparent that the precise details of the methods or compositions described may be varied or modified without departing from the spirit of the described invention. We claim all such modifications and variations that fall within the scope and spirit of the claims below. 

1. A method for detecting an aneuploidy in a fetus, comprising: (a) selectively purifying fetal DNA from a maternal biological sample using the methylation status of a CpG containing genomic sequence, wherein the CpG-containing genomic sequence is at least 15 nucleotides in length, comprises at least one CpG dinucleotide, and is within a region on chromosome 13, 18 or 21, and wherein the CpG-containing genomic sequence comprises at least 15 nucleotides of one of the nucleic acid sequence set forth as any one of SEQ ID NOs: 1-68 and 83; and (b) genotyping the fetus using the purified fetal DNA, thereby detecting aneuploidy in the fetus.
 2. The method of claim 1, wherein genotyping the fetus comprises determining the allelic ratio of a bi-allelic single nucleotide polymorphism in the fetal DNA, wherein an allelic ratio of 1:2 or 2:1 indicates that the fetus is aneuploid.
 3. The method of claim 2, wherein one of SEQ ID NOs: 1-68 or 83, respectively, comprises the single nucleotide polymorphism.
 4. The method of claim 1, wherein genotyping the fetus comprises detecting a short tandem repeat polymorphism in the fetal DNA, and a ratio of bi-allelic short tandem repeats of other than 1:1 indicates that the fetus is aneuploid.
 5. The method of claim 1, wherein selectively purifying fetal DNA from a maternal biological sample using the methylation status of a CpG containing genomic sequence comprises the use of a microarray.
 6. The method of claim 1, wherein selectively purifying fetal DNA from a maternal biological sample using the methylation status of a CpG containing genomic sequence comprises the use of a restriction enzyme that differentially cleaves methylated or unmethylated DNA.
 7. The method of claim 6, wherein the restriction enzyme is Hpa II.
 8. The method of claim 1, wherein selectively purifying fetal DNA from a maternal biological sample using the methylation status of a CpG containing genomic sequence comprises the use of bisulfate.
 9. The method of claim 1, further comprising amplifying the fetal DNA .
 10. The method of claim 1, wherein genotyping the fetus comprises detecting the copy number of a nucleic acid comprising at least 15 nucleotides of one of SEQ ID NOs: 1-68 or 83 in the fetal DNA.
 11. The method of claim 1, wherein genotyping the fetus comprises detecting the copy number of a nucleic acid comprising at least one of SEQ ID NOs: 1-68 and
 83. 12. The method of claim 1, wherein genotyping the fetus comprises detecting the copy number of a bi-allelic single nucleotide polymorphism that is at most 150 nucleotides from one of SEQ ID NOs: 1-68 or
 83. 13. The method of claim 1, wherein genotyping the fetus comprises detecting the copy number of a short tandem repeat that is at most 150 nucleotides from one of SEQ ID NOs: 1-68.
 14. The method of claim 1, wherein detecting the copy number comprises at least one of 1) DNA amplification; 2) detecting a fluorescent signal; 3) detecting hybridization of a probe; and 4) DNA sequencing.
 15. The method of claim 1, wherein the fetal aneuploidy is a trisomy
 18. 16. The method of claim 1, wherein the fetal aneuploidy is trisomy
 21. 17. The method of claim 1, wherein the fetal aneuploidy is trisomy
 13. 18. The method of claim 1, wherein the first biological sample is a maternal blood sample.
 19. The method of claim 1, wherein the fetus is a human fetus.
 20. The method of claim 19, wherein the fetus is between 11 and 13 weeks of age.
 21. The method of claim 1, further comprising karyotyping the fetus. 